***The carrying of a small disc would seem to solve the problem without the risks***

This is exactly my opinion. Why not simply carry a disc with the infromation? We carry ID cards, credit cards, alert bracelets, and passports. There is *absolutely no* need to "imbed" devices into someone's body.

I do agree with moving medical information onto electronic medium. As a doctor I can say there would certianly be the potential for a massive improvement on saving, transferring, updating, and completing medical histories, and delivering care. But, this at the expense of very high risk of losing personal integrity. Especially if a company like MSFT is in control of the software. Don't think for a minute people at msft are immune to bribery. I have good reason to suspect they have ways of hacking into things and their excuse would probably be that it is for law enforcement purposes. The hardware is embedded in the devices so other companies are implicit. Just a thought. Does anyone think Sony which invents means to spy onto people's computers would be above seeing what musical creations someone might have on their computers? I don't.

With regards to the other question I refer to the illegal use of listening devices, tracking devices, probably minute cameras, and God knows what else by "affiliates" of the music "industry". From top to bottom there is a code of silence just like there is in sports industries regardinjg steroids. I can't go into further details at this time. All I am saying is that ID theft is absolutely only the very tip of the iceberg with regards to the criminal activity involving computers, and all the other means of data being placed onto digital records and moved around by electromagnetic spectrum. Law enforcement is so far behind and so poorly equipped it is not funny.

Yet many are in a hurry to move our medical records right onto hardware and software designed by the very companies who have history of not being trustworthy.

AS the noon sun began to cook bathers in Long Beach, N.Y., last Sunday, members of the Sofferman family lounged on towels, each wearing a sun lotion chosen with the care usually given to picking out a new bathing suit.

Skip to next paragraph MultimediaSlide Show What's Your S.P.F.? RelatedThe Value of Seals (July 5, 2007) Denise Sofferman and Ilene Sofferman, sisters who both work in the apparel industry in Manhattan, had put on tanning oil, their bodies already golden brown. Denise’s daughter, Lauren Levy, 21, a student at the University of Pennsylvania, had protected her pale skin with a heavy-duty S.P.F. 50 product formulated for children. Ilene’s 9-year-old daughter, Alison, had received a head-to-toe coating of S.P.F. 30.

Two hours later, the daughters were sunburned, their backs as pink as watermelon.

Ilene Sofferman, smearing another coat of lotion on Alison’s pink face, read from the back of the sunscreen bottle. “They have all these different marketing terms —S.P.F., UVA, UVB, waterproof, sweat-resistant — but you have to figure out what they mean by trial and error,” she said.

After decades of warnings about the dangers of sun exposure, an increasing number of Americans are making sunscreen part of their skin-care routines. Americans bought 60 million units of sunscreen last year, a 13 percent increase compared with 2005, according to Information Resources Inc., which tracks cosmetics sales.

But the increased demand has spurred an explosion of lotions, sprays, pads and gels with such diverse marketing claims — All-day Protection! Ultra Sweatproof! Total Block! Continuous Protection! Ultra Sport! Instant Protection! Extra UVA Protection! — that the Soffermans are not alone in their confusion over how to choose the most effective sunscreen.

In the nearly 30 years since the Food and Drug Administration issued its first regulations for sunscreen as an over-the-counter drug intended to reduce sunburn risk, the science surrounding skin and cancer has expanded dramatically.

Critics have clamored for the F.D.A to update the rules, saying that the standards have not kept pace. At the same time, they complain, the agency has allowed manufacturers to make vague and improbable-sounding marketing claims, leaving consumers confused and, worse, misled about what to use and how to use it to protect themselves.

The pressure on the agency has been mounting in recent weeks. Last month, reports by Consumer Reports and by the Environmental Working Group, a nonprofit group in Washington, found that a variety of popular sunscreens lacked sufficient broad protection against the sun’s harmful rays. And in May, Richard Blumenthal, Connecticut’s attorney general, sent a scathing petition to the F.D.A. saying that unclear sunscreen labels and inflated marketing put people at risk.

“Most sunscreens are deceptively and misleadingly labeled, most perniciously to give consumers a false sense of security,” Mr. Blumenthal said last week. “In my view, the F.D.A.’s failure to act is unconscionable and unjustifiable in any public sense.”

John Bailey, the executive vice president for science at the Cosmetics, Toiletry and Fragrance Association, an industry trade group, said that the directions on sunscreens adequately convey coverage. “These are very beneficial products which should be used to protect against the adverse effects of sunlight,” said Dr. Bailey, who has a Ph.D. in chemistry.

Nonetheless, the F.D.A. seems poised to address the labeling issue. Although it has been planning since 1999 to confirm new rules, Rita Chappelle, a spokeswoman for the F.D.A., said the agency expected to issue new sunscreen standards in the coming weeks. But until they are released, Ms. Chappelle said the agency would not answer questions about forthcoming regulations.

One fact about sunscreens is indisputable: They can impede sunburn and lower the incidence of at least one form of skin cancer in humans.

Dr. Allan C. Halpern, chief of dermatology at Memorial Sloan-Kettering Cancer Center in Manhattan, said that the regular use of sunscreen can inhibit squamous cell carcinoma, a cancer that kills 2,000 to 2,500 Americans a year.

In a study of about 1,600 residents of Nambour, Australia, volunteers who were given sunscreen to use every day for four and a half years had 40 percent fewer squamous cell cancers than a control group who maintained their normal skin-care routines. Even 10 years after the study concluded, the volunteers assigned to use sunscreen during the trial period had fewer cancers.

“It shows that using sun protection for almost five years gives you an intense, longer-term benefit against squamous cell carcinoma,” said Dr. Adèle C. Green, deputy director of the Queensland Institute of Medical Research in Brisbane, Australia, which ran the study.

Dr. Halpern said that sunscreen should also protect against melanoma, the deadliest skin cancer, and basal cell carcinoma, because the product can inhibit harmful ultraviolet rays that can contribute to the diseases.

Yet even after new F.D.A. labeling rules are published, it may take two years for the changes take effect.

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Dr. James M. Spencer, a dermatologist in St. Petersburg, Fla., who specializes in skin cancer, said that he hopes the updated standards will clarify how much protection sunscreens provide, the dose needed to achieve significant protection, and the frequency with which a sunscreen should be reapplied.

Skip to next paragraph MultimediaSlide Show What's Your S.P.F.? RelatedThe Value of Seals (July 5, 2007) The F.D.A. in 1978 first proposed a system of labeling products with an S.P.F. or Sun Protection Factor, which measures how effective the product is in preventing burn caused by the sun’s ultraviolet B rays. UVB radiation can also be a factor in skin cancer.

Dr. Spencer said that an S.P.F. 15 product screens about 94 percent of UVB rays while an S.P.F. 30 product screens 97 percent. Manufacturers determine the S.P.F. by dividing how many minutes it takes lab volunteers to burn wearing a thick layer of the product by the minutes they take to burn without the product.

But people rarely get the level of S.P.F. listed because labels do not explain how much to use, said Dr. Vincent A. DeLeo, chairman of dermatology at St. Luke’s-Roosevelt Hospital Center in Manhattan.

“Sunscreen is tested at 2 milligrams per square centimeter of skin, which means you should be using two ounces each time to cover your whole body,” Dr. DeLeo said. “But for most people an eight-ounce bottle lasts the whole summer.”

People who apply S.P.F. 30 too sparingly, for example, may end up with only S.P.F. 3 to S.P.F. 10, according to the Web site of the British Columbia Centre for Disease Control, www.bccdc.org/downloads/pdf/rps/reports/RIN15.pdf, which has comprehensive guidelines.

“The S.P.F. is a terrible system to guide consumers,” Dr. Spencer said. “Nobody is using sunscreen the way it is measured in a lab.” He said he hopes that the new standards will call for S.P.F. to be replaced with a system defining sun protection as high, medium or low.

Until then, Dr. Spencer said that people should use about a shot glass of sunscreen for the body and a teaspoon for the face to best achieve the S.P.F. protection listed on labels. It should be reapplied every few hours and immediately after swimming or sweating.

Dermatologists said that the agency is also likely to introduce a rating system for the sun’s ultraviolet A rays, which can contribute to cancer and skin aging. Many products already contain UVA screening agents, but under the current rules there is no rating for them.

Manufacturers are catching on that some consumers seek UVA protection. In print advertisements this month, Neutrogena and Banana Boat have been battling for UVA supremacy, including graphs in which each shows their product offering the highest coverage.

But Dr. David M. Pariser, the president-elect of the American Academy of Dermatology, said that without a standardized UVA rating system, consumers can’t be sure how much a sunscreen provides.

“Right now, we don’t know whether doubling the percentage of a UVA sunscreen ingredient doubles UVA protection or not,” Dr. Pariser said. “That is part of the muddled system we hope will be cleared up.”

Until then, Dr. Pariser said to choose sunscreens that contain ingredients known to filter UVA. These include Mexoryl SX, avobenzone, titanium dioxide and zinc oxide. He also recommended a database at www.cosmeticsdatabase.com/special/sunscreens/summary.php created by the Environmental Working Group that lists products with UVA protection.

Some doctors, along with Mr. Blumenthal of Connecticut, predicted that the new sunscreen rules would prohibit outsized marketing terms.

“ ‘All-day protection’ is just plain false since sunscreen has to be frequently reapplied,” Mr. Blumenthal said. “And ‘waterproof,’ which may be O.K. for an adult taking a quick dip in the pool but not for kids who are in and out of the water all day, is just plain deceptive.”

Dr. Green in Australia said the best way to prevent skin cancer is to stay out of the sun during peak hours and wear sun-protective clothing. But Dr. Halpern said you can’t keep Americans wrapped up.

“There is only a small subset of American society that is willing to wear long-sleeved shirts and wide-brimmed — defined as four inches wide — hats on a sunny day at the beach,” he said. “Until we can get that behavior, the next best thing is sunscreen. Put on two coats, so you won’t miss any spots.”

Several months ago I started screening patient's 25 OH vitamin D levels and am surprised to find how frequently it is coming back low. There is a quiet revolution going on with how medicine is viewing Vitamin D. I believe it should be standard to screen many if not alll patient's levels. The historicly recommended daily intake of 400IU per day is grossly inadequate and now outdated. It is now recommended that we take higher doses. Low levels of Vitamin D is linked to many more illnesses than just those relating to bone disorders. A very good review article was published in the recent New England Journal of Medicine. I don't know if I should post the entire article here, but here are the final conclusions. I think it very important that patients start asking their doctors about Vitamin D intake and even consider getting their vitamin D level checked. I also conclude it is important for doctors to talk more to patients about this.

I am convinced we will all be hearing a lot more about vitamin D in the lay media. It may likely be the next big topic for mass media coverage which just loves a good health story. OK Sanjay Gupta. Here is your chance to make up for your rather weak performance against Michael Moore.

Conclusions

Undiagnosed vitamin D deficiency is not uncommon,1,2,3,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,123 and 25-hydroxyvitamin D is the barometer for vitamin D status. Serum 25-hydroxyvitamin D is not only a predictor of bone health8 but is also an independent predictor of risk for cancer and other chronic diseases.8,54,59,60,61,62,63,64,71,72,73,74,75,83,84,85 The report that postmenopausal women who increased their vitamin D intake by 1100 IU of vitamin D3 reduced their relative risk of cancer by 60 to 77% is a compelling reason to be vitamin D–sufficient.124 Most commercial assays for 25-hydroxyvitamin D are good for detecting vitamin D deficiency. Radioimmunoassays measure total 25-hydroxyvitamin D, which includes levels of both 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3. Some commercial laboratories measure 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 with liquid chromatography and tandem mass spectroscopy and report the values separately. As long as the combined total is 30 ng per milliliter or more, the patient has sufficient vitamin D.7,14,27 The 1,25-dihydroxyvitamin D assay should never be used for detecting vitamin D deficiency because levels will be normal or even elevated as a result of secondary hyperparathyroidism. Because the 25-hydroxyvitamin D assay is costly and may not always be available, providing children and adults with approximately at least 800 IU of vitamin D3 per day or its equivalent should guarantee vitamin D sufficiency unless there are mitigating circumstances (Table 2).

Much evidence suggests that the recommended adequate intakes are actually inadequate and need to be increased to at least 800 IU of vitamin D3 per day. Unless a person eats oily fish frequently, it is very difficult to obtain that much vitamin D3 on a daily basis from dietary sources. Excessive exposure to sunlight, especially sunlight that causes sunburn, will increase the risk of skin cancer.125,126 Thus, sensible sun exposure (or ultraviolet B irradiation) and the use of supplements are needed to fulfill the body's vitamin D requirement.

In the article are published reports of inadequate vitamin D with many illness and diseases but it is unclear how clinically significant these "links" are. The classic one is weak bone or osteoposis which is actually without symptoms until fractures in the spine occur, or in the hip or wrists or in the ribs after a fall occurs. In the article the author points a possible link of Vit D and several cancers:Hodgkins lymphoma, ovarian, prostate, pancreatic, breast, colon.

Links with the malfunction of the immune system and 1) with autoimmune diseases:Multiple sclerosis, Diabetes type 1, Crohn's, Sarcoidosis, rheumatoid arthritis2) infections:TB, Aids

Links with:Schizophrenia and depression

With muscle strength and falls and osteoarthritis

With hypertension

With wheezing

With fibromyalgia, chronic fatigue syndrome, and achiness.

Some of these linkages are a bit tenuous and are based on observational studies which show an increased risk at those people who live at higher geographical latitudes (less sun exposure). But I take away from this article an impression that the overall large quantity of evidence supoorts the theory that vitamin D is far more important in *many more* aspects of our health than we have thought.

From the article is a table that summarizes sources of vitamin D. It is very difficult to get adequate amounts from our diet alone.The source from UV radiation (the sun) depends on season, time of day latitude and skin sensitivity. Five to ten minutes a day might be enough to get the O.5 minimal erythemal dose. I have read in other places that this still does not give enough people adequate Vitamin D stores.

One of my patients came in and told me he came up positive for lead in an employer urine drug screen. He said his daughter also was slightly positive.

We brainstormed to consider a source. His house was built in the 1990's so I doubt lead from paint would be implicated. He did not have an obvious work exposure. Then over the next few days came out the reports of Fisher-Price toys made in China have unexceptable lead levels. I mentioned this ASAP to the patient's wife whom I see regularly. They have a one year old and newly bought Fisher-Price toys. I recommended they not throw them out but of course store them far away from the family.

Antibiotic Runoff Sign In to E-Mail or Save This Print ShareDiggFacebookNewsvinePermalink

Published: September 18, 2007One of the persistent problems of industrial agriculture is the inappropriate use of antibiotics. It’s one thing to give antibiotics to individual animals, case by case, the way we treat humans. But it’s a common practice in the confinement hog industry to give antibiotics to the whole herd, to enhance growth and to fight off the risk of disease, which is increased by keeping so many animals in such close quarters. This is an ideal way to create organisms resistant to the drugs. That poses a risk to us all.

A recent study by the University of Illinois makes the risk even more apparent. Studying the groundwater around two confinement hog farms, scientists have identified the presence of several transferable genes that confer antibiotic resistance, specifically to tetracycline. There is the very real chance that in such a rich bacterial soup these genes might move from organism to organism, carrying the ability to resist tetracycline with them. And because the resistant genes were found in groundwater, they are already at large in the environment.

There are two interdependent solutions to this problem, and hog producers should embrace them both. The first solution — the least likely to be acceptable in the hog industry — is to ban the wholesale, herdwide use of antibiotics. The second solution is to continue to tighten the regulations and the monitoring of manure containment systems. The trouble, of course, is that there is no such thing as perfect containment.

The consumer has the choice to buy pork that doesn’t come from factory farms. The justification for that kind of farming has always been efficiency, and yet, as so often happens in agriculture, the argument breaks down once you look at all the side effects. The trouble with factory farms is that they are raising more than pigs. They are raising drug-resistant bugs as well. NY Times

MIT finds cure for fearSubmitted by Vidura Panditaratne on Sun, 2007-07-15 19:37. MIT biochemists have identified a molecular mechanism behind fear, and successfully cured it in mice, according to an article in the journal Nature Neuroscience.

Researchers from MIT's Picower Institute for Learning and Memory hope that their work could lead to the first drug to treat the millions of adults who suffer each year from persistent, debilitating fears - including hundreds of soldiers returning from conflict in Iraq and Afghanistan.

Inhibiting a kinase, an enzyme that change proteins, called Cdk5 facilitates the extinction of fear learned in a particular context, Li-Huei Tsai, Picower Professor of Neuroscience in the Department of Brain and Cognitive Sciences, and colleagues showed.

Conversely, the learned fear persisted when the kinase's activity was increased in the hippocampus, the brain's center for storing memories, the scientists found.

Cdk5, paired with the protein p35, helps new brain cells, or neurons, form and migrate to their correct positions during early brain development, and the MIT researchers looked at how Cdk5 affects the ability to form and eliminate fear-related memories.

Emotional disorders such as post-traumatic stress and panic attacks stem from the inability of the brain to stop experiencing the fear associated with a specific incident or series of incidents.

For some people, upsetting memories of traumatic events do not go away on their own, or may even get worse over time, severely affecting their lives.

A study conducted by the Army in 2004 found that one in eight soldiers returning from Iraq reported symptoms of post-traumatic stress disorder (PTSD).

According to the National Center for PTSD in the United States, around eight percent of the population will have PTSD symptoms at some point in their lives. Some 5.2 million adults have PTSD during a given year, the center reports.

In the current research, genetically engineered mice received mild foot shocks in a certain environment and were re-exposed to the same environment without the foot shock.

The team found that mice with increased levels of Cdk5 activity had more trouble letting go of the memory of the foot shock and continued to freeze in fear.

The reverse was also true: in mice whose Cdk5 activity was inhibited, the bad memory of the shocks disappeared when the mice learned that they no longer needed to fear the environment where the foot shocks had once occurred.

"In our study, we employ mice to show that extinction of learned fear depends on counteracting components of a molecular pathway involving the protein kinase Cdk5," Tsai concluded. "We found that Cdk5 activity prevents extinction, at least in part by negatively affecting the activity of another key kinase."

In 1988, the surgeon general, C. Everett Koop, proclaimed ice cream to a be public-health menace right up there with cigarettes. Alluding to his office’s famous 1964 report on the perils of smoking, Dr. Koop announced that the American diet was a problem of “comparable” magnitude, chiefly because of the high-fat foods that were causing coronary heart disease and other deadly ailments. He introduced his report with these words: “The depth of the science base underlying its findings is even more impressive than that for tobacco and health in 1964.”

That was a ludicrous statement, as Gary Taubes demonstrates in his new book meticulously debunking diet myths, “Good Calories, Bad Calories” (Knopf, 2007). The notion that fatty foods shorten your life began as a hypothesis based on dubious assumptions and data; when scientists tried to confirm it they failed repeatedly. The evidence against Häagen-Dazs was nothing like the evidence against Marlboros.

It may seem bizarre that a surgeon general could go so wrong. After all, wasn’t it his job to express the scientific consensus? But that was the problem. Dr. Koop was expressing the consensus. He, like the architects of the federal “food pyramid” telling Americans what to eat, went wrong by listening to everyone else. He was caught in what social scientists call a cascade.

We like to think that people improve their judgment by putting their minds together, and sometimes they do. The studio audience at “Who Wants to Be a Millionaire” usually votes for the right answer. But suppose, instead of the audience members voting silently in unison, they voted out loud one after another. And suppose the first person gets it wrong.

If the second person isn’t sure of the answer, he’s liable to go along with the first person’s guess. By then, even if the third person suspects another answer is right, she’s more liable to go along just because she assumes the first two together know more than she does. Thus begins an “informational cascade” as one person after another assumes that the rest can’t all be wrong.

Because of this effect, groups are surprisingly prone to reach mistaken conclusions even when most of the people started out knowing better, according to the economists Sushil Bikhchandani, David Hirshleifer and Ivo Welch. If, say, 60 percent of a group’s members have been given information pointing them to the right answer (while the rest have information pointing to the wrong answer), there is still about a one-in-three chance that the group will cascade to a mistaken consensus.

Cascades are especially common in medicine as doctors take their cues from others, leading them to overdiagnose some faddish ailments (called bandwagon diseases) and overprescribe certain treatments (like the tonsillectomies once popular for children). Unable to keep up with the volume of research, doctors look for guidance from an expert — or at least someone who sounds confident.

In the case of fatty foods, that confident voice belonged to Ancel Keys, a prominent diet researcher a half-century ago (the K-rations in World War II were said to be named after him). He became convinced in the 1950s that Americans were suffering from a new epidemic of heart disease because they were eating more fat than their ancestors.

There were two glaring problems with this theory, as Mr. Taubes, a correspondent for Science magazine, explains in his book. First, it wasn’t clear that traditional diets were especially lean. Nineteenth-century Americans consumed huge amounts of meat; the percentage of fat in the diet of ancient hunter-gatherers, according to the best estimate today, was as high or higher than the ratio in the modern Western diet.

Second, there wasn’t really a new epidemic of heart disease. Yes, more cases were being reported, but not because people were in worse health. It was mainly because they were living longer and were more likely to see a doctor who diagnosed the symptoms.

To bolster his theory, Dr. Keys in 1953 compared diets and heart disease rates in the United States, Japan and four other countries. Sure enough, more fat correlated with more disease (America topped the list). But critics at the time noted that if Dr. Keys had analyzed all 22 countries for which data were available, he would not have found a correlation. (And, as Mr. Taubes notes, no one would have puzzled over the so-called French Paradox of foie-gras connoisseurs with healthy hearts.)===========

The evidence that dietary fat correlates with heart disease “does not stand up to critical examination,” the American Heart Association concluded in 1957. But three years later the association changed position — not because of new data, Mr. Taubes writes, but because Dr. Keys and an ally were on the committee issuing the new report. It asserted that “the best scientific evidence of the time” warranted a lower-fat diet for people at high risk of heart disease.

The association’s report was big news and put Dr. Keys, who died in 2004, on the cover of Time magazine. The magazine devoted four pages to the topic — and just one paragraph noting that Dr. Keys’s diet advice was “still questioned by some researchers.” That set the tone for decades of news media coverage. Journalists and their audiences were looking for clear guidance, not scientific ambiguity.

After the fat-is-bad theory became popular wisdom, the cascade accelerated in the 1970s when a committee led by Senator George McGovern issued a report advising Americans to lower their risk of heart disease by eating less fat. “McGovern’s staff were virtually unaware of the existence of any scientific controversy,” Mr. Taubes writes, and the committee’s report was written by a nonscientist “relying almost exclusively on a single Harvard nutritionist, Mark Hegsted.”

That report impressed another nonscientist, Carol Tucker Foreman, an assistant agriculture secretary, who hired Dr. Hegsted to draw up a set of national dietary guidelines. The Department of Agriculture’s advice against eating too much fat was issued in 1980 and would later be incorporated in its “food pyramid.”

Meanwhile, there still wasn’t good evidence to warrant recommending a low-fat diet for all Americans, as the National Academy of Sciences noted in a report shortly after the U.S.D.A. guidelines were issued. But the report’s authors were promptly excoriated on Capitol Hill and in the news media for denying a danger that had already been proclaimed by the American Heart Association, the McGovern committee and the U.S.D.A.

The scientists, despite their impressive credentials, were accused of bias because some of them had done research financed by the food industry. And so the informational cascade morphed into what the economist Timur Kuran calls a reputational cascade, in which it becomes a career risk for dissidents to question the popular wisdom.

With skeptical scientists ostracized, the public debate and research agenda became dominated by the fat-is-bad school. Later the National Institutes of Health would hold a “consensus conference” that concluded there was “no doubt” that low-fat diets “will afford significant protection against coronary heart disease” for every American over the age of 2. The American Cancer Society and the surgeon general recommended a low-fat diet to prevent cancer.

But when the theories were tested in clinical trials, the evidence kept turning up negative. As Mr. Taubes notes, the most rigorous meta-analysis of the clinical trials of low-fat diets, published in 2001 by the Cochrane Collaboration, concluded that they had no significant effect on mortality.

Mr. Taubes argues that the low-fat recommendations, besides being unjustified, may well have harmed Americans by encouraging them to switch to carbohydrates, which he believes cause obesity and disease. He acknowledges that that hypothesis is unproved, and that the low-carb diet fad could turn out to be another mistaken cascade. The problem, he says, is that the low-carb hypothesis hasn’t been seriously studied because it couldn’t be reconciled with the low-fat dogma.

Mr. Taubes told me he especially admired the iconoclasm of Dr. Edward H. Ahrens Jr., a lipids researcher who spoke out against the McGovern committee’s report. Mr. McGovern subsequently asked him at a hearing to reconcile his skepticism with a survey showing that the low-fat recommendations were endorsed by 92 percent of “the world’s leading doctors.”

“Senator McGovern, I recognize the disadvantage of being in the minority,” Dr. Ahrens replied. Then he pointed out that most of the doctors in the survey were relying on secondhand knowledge because they didn’t work in this field themselves.

“This is a matter,” he continued, “of such enormous social, economic and medical importance that it must be evaluated with our eyes completely open. Thus I would hate to see this issue settled by anything that smacks of a Gallup poll.” Or a cascade.

This week, the National Cancer Institute, in conjunction with other organizations that track cancers, reported that the death rate from cancer declined from 2002-2004 by an average of 2.1% per year. This is an improvement over the 1.1% annual declines from 1993-2002 and is very good news indeed. Each 1% decline represents 5,000 people living rather than dying, and, of course, this figure is compounded each year.

While some part of the declining death rate from cancer is the consequence of screening, much is the result of greatly improved treatments. And we believe that the successes achieved to date are only the modest beginning of a revolution in the research into and treatment of cancer.

During the last half of the 20th century, almost all treatments of cancers involved forms of chemotherapy in which cancerous and normal tissues were bombarded with nonselective cytoxic drugs. These drugs killed all cells, healthy as well as malignant. Worse, they did not kill all cancer cells, so the cancer progressed -- leading to the pessimism dominant in people's minds today, a reflection of years of articles and opinion pieces in the popular press expressing the view that "the war on cancer" has been waged incorrectly, if not lost.

Now, however, new therapeutic modes are in play, based on better understandings of cancers and great advances in technologies. Scientists are at last on the right track and making progress along three fronts. First, many cancers will be turned into chronic illnesses, each treated with far less toxic drugs with far fewer and less severe side effects, so that a patient can live a normal life span with a near normal quality of life. (A loose analogy would be to diabetics.) These treatments are probably closer to being realized than most people would guess.

Second, the prevention of entire types of cancers will occur through vaccinations, an approach already in clinical use. Third, cancers already growing in individuals will be eradicated. Here is just a partial list of the new approaches:

• Vaccines. Today, a newly developed vaccine is being administered to females, ages 11-26, that prevents cervical cancer (and anal cancer). The vaccine targets a certain virus, human papillomavirus (HPV), which is the cause of most cervical cancers. (Cervical cancer kills 4,000 women annually in the U.S., and 500,000 world-wide.) It is thought that infection with viruses or bacteria play a role in the development of other cancers, e.g., lymphoma and stomach cancer, and research is focused on vaccines and antibiotics to prevent these, and to eradicate those cancers already in existence in individuals.

Another area of vaccine research is Hepatitis C virus (HCV) infection, which causes most liver cancer in the Western world, and Hepatitis B virus (HBV), which causes liver cancer in Asia. (It should be noted that only in a very small percentage of people who have the infections do the viruses cause liver cancer.) Researchers are looking into the possible implications for humans of laboratory results which show that mammary (breast) cancer can be caused in mice by introduction of a virus, a virus which is normally passed from one mouse to another.

In the past, success in stimulating the human immune system to attack cancer cells has been elusive. But three novel research projects are underway, aimed at highly lethal metastatic melanoma. The first approach involves T cells (a group of white blood cells that play a critical role in immunity) which have a particular receptor on their surface known as "TCR" that activates the immune system. The process extracts T cells from a patient's blood sample and, in a laboratory, activates their TCR to turn the T cells into killers of the patient's melanoma cells, and not healthy cells, when reinjected into the patient.

The second approach involves genetic modification of a patient's white blood cells in a laboratory. The cells then produce a protein that enables the modified white cells to be detected and counted in tumors anywhere and everywhere in the patient's body using a noninvasive PET scan, a sophisticated X-ray technology.

In the third method, certain T cells which are derived from blood-forming stem cells are genetically manipulated to target and attack melanoma cells. These killer cells replicate in the body in response to the presence of melanoma tumors and attack the cancerous cells -- and because stem cells are long-lived, a large supply of the cancer-killing cells develop in the patient's body for as long as they are needed, i.e., as long as there are melanoma cells there.

- Epigenetics. Cancers are caused by mutations in DNA and abnormal control of genetic expressions. Epigenetic therapy involves correcting and reversing abnormal cancer-causing gene expressions through the use of drugs designed to target specific proteins involved in gene control.

In 1989, a drug removing the abnormal protein causing acute promyelocytic leukemia (APL) was first successfully used. Since then, the cure rate for APL has gone to 90% and 50,000 lives have been saved world-wide. In the past three years the FDA has approved three epigenetic drugs that can change the behavior of malignant genes by acting on the proteins that control them. They act on cutaneous lymphoma, acute leukemia and myelodysplastic syndrome (a common form of blood cancer).

The most difficult-to-treat cancers involve many mutations involving many gene "switches" that turn on or off the flow of information passed from one gene to another. In our high-speed information age, we are moving to the point where we can keep up with them, and thus "edit" and control them in specific, selective ways.

• Targeted therapies. The use of personalized malignant gene-expression profiles has advanced from research to therapy in patients, e.g., in breast cancer. Research is advancing in targeting specific mutations in some lymphomas, lung cancer and leukemia.

Progress is also well underway in learning to control abnormal genes which signal normal genes to aid in the nurturing of cancers or in metastases of cancers. For example, doctors now have drugs that are able to curtail the production of new blood vessels which cancer cells need and cause to be produced, thus depriving the cancers of nourishment, thereby killing them. Drugs have been designed to block abnormal signals from an individual patient's cancer, and are in use or development.

Biomarkers to detect ongoing cancers are another fruitful area of research. An example of a biomarker now being used clinically is an overabundance of a protein (called HER-2 neu) which is associated with many breast cancers. Such personalized molecular profiles lead to the use of specific, highly selective treatments with minimal toxicity.

• Cancer "stem cells." Intensive, continuing research has identified a type of cancer cells, found in small numbers, that are more capable of producing cancers and are more difficult to eradicate than ordinary cancer cells. In the last five years, knowledge has greatly advanced regarding how these types of cancer stem cells operate at the genetic level. Work is also well underway in the specific targeting, through the rapid expansion of computer data bases, of the genetic signatures of stem cells of different cancers, to inhibit or cancel their ability to communicate information that causes cancer growth, dormancy and metastasis.

This is but a very incomplete account of new and increasingly productive research in understanding and defeating cancers. In all, there is a 21st-century cancer treatment revolution unfolding. Defeating cancers involves incremental, time-consuming processes along many avenues -- and we are advancing on all of them.

The danger is that misconceived pessimism might result in a loss of popular moral support for the revolutionary new approaches to cancer research and treatment. This in turn could lead to diminishing private and governmental funds for research.

At the very least, pessimism about taming and ultimately eliminating cancers turns the minds of millions from what should be justified hope to needless despair.

Dr. Waxman, an oncologist, is professor of medicine at Mount Sinai Medical Center and scientific director of the Samuel Waxman Cancer Research Foundation. Mr. Gambino, who has a Ph. D. in philosophy, is professor emeritus at Queens College (CUNY).

Putting Superbugs on the DefensiveHospitals Begin to ToutAbility to Control Infection;Mining the Available DataBy THEO FRANCISOctober 23, 2007; Page D1

Hospitals are prime breeding grounds for antibiotic-resistant "superbugs" that kill tens of thousands of Americans each year. But most people have had no way of knowing how well their hospital keeps these bacteria -- and infections in general -- under control.

Concern over the spread of Methicillin-resistant Staphylococcus aureus has prompted renewed calls for preventive measures such as handwashing and the cleaning of facilities and schools where cases have been found. That is starting to change. Nineteen states have adopted laws in recent years requiring hospitals to report overall infection rates publicly, with more likely to follow suit. And Thursday, nearly two dozen federal lawmakers, headed by Pennsylvania Rep. Tim Murphy, proposed legislation requiring nationwide public reporting.

So far, just four states have published some infection rates for individual hospitals, and only one state, Pennsylvania, breaks out different types of infections. But even where patients can't find state-mandated infection reports, they can increasingly get information from their local hospital about practices to prevent superbugs and other infections. Some hospitals have found a marketing opportunity in infection prevention: They are pushing overall infection rates toward zero -- and advertising it. They are trumpeting prevention efforts, such as campaigns to improve hand washing. And some are tracking patients who have been infected with superbugs such as methicillin-resistant Staphylococcus aureus, or MRSA, and monitoring them to prevent the spread.

"This is one of those cases where quality is also the best business case," says Jonathan Perlin, chief medical officer at hospital chain HCA Inc., which has enlisted staffers and visitors alike in its own campaign to keep germs away from patients.

While antibiotic-resistant infections have gotten the attention of late, hospitals have long struggled with infections of all kinds. Common bacteria including Staphylococcus aureus can infect the bloodstream, urinary tract, lungs or surgical incisions of patients whose immune systems are already compromised. Over time, some strains of these bacteria have developed powerful defenses against antibiotics, leaving them harder to kill.

Hospitals have long attempted to keep infection rates low, but the spread of resistant strains has made the fight that much more urgent in recent years. Last week, concerns came to a head with a new study showing that antibiotic-resistant infections are probably far more extensive than previously thought. The study published in JAMA, the Journal of the American Medical Association, concluded that MRSA causes 94,000 infections a year. The study estimated that MRSA, one of the biggest infection concerns in hospitals, contributes to nearly 19,000 deaths. The vast majority were linked to health care, including hospitals, nursing homes, dialysis and others.

At the same time, recent student illnesses and deaths have prompted school closings in some states. (Please see related article.) And starting next year, Medicare will no longer reimburse hospitals for some infections acquired after admission, in an effort both to encourage vigilance and to save money.

BUG OFF

Hospital chain HCA has taken its campaign against antibiotic-resistant infections to the public as well as its medical staff. Below, links to a handout for visitors to HCA hospitals, and a poster aimed at employees.• Handout: Stopping Infections Is In Your Hands• Poster: Stopping MRSA Is In Your HandsAmong the four states that have published infection rates, Missouri and Vermont let consumers learn the number of blood infections related to central lines -- tubes inserted into or near the heart, often to give medications or fluids -- and how that compares with state or national averages. Pennsylvania provides multiple reports on different kinds of infections, and lets consumers look up infection-related mortality, length-of-stay and cost data for several kinds of infections. A Web site from Consumers Union, www.stophospitalinfections.org, has links to reports from each state, including Florida, according to Lisa McGiffert, director of the Stop Hospital Infections Campaign.

'Ahead of the Curve'

Information from Florida is nearly two years old, and Missouri's dates to December 2006. But the information released so far is an important start, say public-health experts, since most of the hospital-infection reports mandated by the new state laws won't be available before about 2009. "Those states that have already released data are ahead of the curve," says John Jernigan, a medical epidemiologist with the Centers for Disease Control and Prevention in Atlanta.

So far, infection reports available to the public aren't consistent enough to allow consumers to compare hospitals across state lines, and even comparing facilities within a state can be tricky. Some facilities may treat sicker patients, for example, who are more likely to become infected when exposed to MRSA or other resistant bugs.

Indeed, the data are probably too technical for most consumers, says Carlene Muto, medical director of infection control at the University of Pittsburgh Medical Center. Still, she is a strong supporter of the reporting requirements as a way to push hospitals to improve. "Clearly, it's a good idea just to measure adverse events," she says. "You can't change what you do not measure, because you won't know that it's broken."

In areas where patients can't learn actual infection rates, they can watch for key signs that a hospital is on top of preventing both superbugs and infections generally. National studies suggest, for example, that hospital personnel don't wash their hands nearly as often as they should.

Nashville, Tenn.-based HCA has been putting up posters exhorting doctors to wash their hands, and is even distributing a card to visitors that explains the importance of hand washing when coming in contact with patients. The company says its purchases of hand-sanitizing alcohol gel -- available from dispensers throughout its hospitals -- have risen 600% since early this year. (Company officials say they didn't measure infection rates at the start of the campaign and so don't know how much infections have fallen.)

Other hospitals say they have pushed antibiotic-resistant-infection rates down sharply through a combination of techniques. The University of Pittsburgh Medical Center, for example, has cut MRSA infection rates in half at its main hospital since 2001 in part by screening all intensive-care patients to see if they are carrying the bug; it is now expanding use of the tests.

To reduce certain kinds of bloodstream infections, the 19-hospital system bundles sterile material needed to insert central lines and has stepped up training; central-line associated blood-infection rates have fallen by 80% since 2002, to fewer than one per thousand such procedures.

It also has taken steps to deal with the emergence of a different strain of bacteria that can cause potentially fatal diarrhea. The hospital lets nurses order tests for the bug; requires longer isolation periods for those infected with it; gives their rooms an additional cleaning with bleach; and requires physicians to get approval from an antibiotic-management team when using certain high-powered antimicrobials that could affect the body's natural defenses against the bacteria. UPMC's infection rates for the organism, Clostridium difficile, have fallen two-thirds since a spike in 2000.

Intermountain Healthcare, a Salt Lake City-based chain of 21 hospitals, keeps a database of every patient who has been infected with MRSA. Those who return to the hospital for some other reason are immediately monitored by an infection-control nurse and tested to see if they are carrying the bacteria.

"Those patients are at higher risk of potentially getting it again, and at higher risk of spreading it to other patients," says the hospital's chief medical officer, Brent Wallace. Together with a concerted campaign to improve hand-washing, the database has helped stop an increase in the number of MRSA infections at the hospital over the past year, he says.

Broader Testing

Some states are also beginning to mandate broader testing specifically for MRSA, since patients can carry the bug and spread it without showing signs of infection. Pennsylvania will soon require hospitals to test high-risk patients, including those admitted from nursing homes. In August, New Jersey and Illinois adopted legislation requiring hospitals to identify patients carrying MRSA and isolate them, among other provisions.

Don Goldmann, senior vice president of the Institute for Health Care Improvement and a Harvard Medical School pediatrics professor, says that factors beyond infection rates should play into picking a hospital. "There may be a lot of information to weigh."

On their own, some hospitals have been turning to a variety of new technologies to try to cut down on infections, particularly superbugs, ranging from antibiotic-coated catheters to work surfaces made of copper, which has antimicrobial properties, as well as software. For several years, many hospitals have also participated in federally sponsored programs to reduce surgical complications, including infections acquired in the hospital.

As a virulent strain of antibiotic-resistant bacteria spreads beyond hospital walls, some communities are taking extreme measures such as closing schools for disinfection. But getting adults and children to pay better attention to a few simple personal-hygiene rules, and taking precautionary measures such as getting a flu shot, may be a far more effective weapon against the bugs.

New reports of deaths and infections across the country coincided with a report last week from the Centers for Disease Control and Prevention indicating that about 94,000 people annually are infected with methicillin-resistant staphylococcus aureus, or MRSA, a form of the common staph bacteria that has become resistant to penicillin and related antibiotics. While the CDC estimated that the majority of such infections occur in health-care settings, nearly 14% were so-called community-acquired, meaning that they struck otherwise healthy people who weren't in a hospital. Indeed, a number of the staph infections reported in recent weeks involved outbreaks among student athletes.

Staph bacteria frequently live on the skin and in the nose without causing any health problems, and at any time about a third of people are already "colonized." But if the bacteria enter the skin or bloodstream through a cut or lesion, or a person's immune system is weakened by flu or other causes, a staph infection can set in. Although the organism can be spread by patients who are colonized but not infected through casual contact or through contaminated objects, such spread can occur more quickly from patients with active skin infections unless the appropriate precautions are taken.

Staph infections can often be treated by simply cleaning and draining a wound. Even if the strain turns out to be MRSA, antibiotics may not be necessary, and severe cases may be treated with antibiotics such as vancomycin. But such cases can also progress to severe invasive disease and death.

CDC officials stress that the number of such infections is still relatively low, and children ages 5 to 17 years have the lowest rate of MRSA infection of any age group. The overall physical environment, moreover, hasn't played a significant role in the transmission of MRSA. Transmission occurs with direct contact with an infected person or contaminated items, such as sporting equipment or clothing. So scrubbing down locker-room walls as if they were a biohazard hot zone isn't going to protect kids as well as making sure that they keep their hands clean, cover open wounds with clean, dry bandages, and avoid sharing personal items such as towels, razors or uniforms. Says John Jernigan, an MRSA expert at the CDC: "If we can hammer that message home, we will go a long way towards preventing infections."

In team sports it is also important to exclude players who have potentially infected skin lesions if their wounds can't be covered. Other measures include washing clothes, especially uniforms and exercise gear, in hot water and laundry detergent and drying them in a hot dryer. (For more information on infection prevention techniques, check cdc.gov.)

Such common-sense measures apply to protecting yourself and your children from other kinds of infections as well. In most places where people share facilities or water, bacteria can spread. That resort hot tub may look inviting, but there is always a risk that the others sharing it don't have pristine personal hygiene; so-called recreational water illnesses can cause skin, ear, respiratory, eye, neurologic and wound infections. If you are getting a salon pedicure, don't shave your legs beforehand, because any bacteria in a salon's foot baths, including MRSA, can enter the skin or bloodstream through minor nicks. Ensure that the foot bath basin is thoroughly sanitized, and bring your own equipment, such as clippers.

Proper hand-washing techniques are critical, says Jason Newland, an infectious-disease expert at Children's Mercy Hospital in Kansas City, Mo., because bacteria often are transmitted when people touch their mouth or nose. The quick pass of the hands under a lukewarm or cool faucet many of us rely on won't do the trick; it is important to wash hands for at least 15 seconds in hot water and rub soap vigorously to create enough friction to rub off contaminants. If using an antibacterial gel, it is also important to create friction through rubbing -- and to make sure the gel dries completely. With flu season at hand, Dr. Newland says a flu shot is advisable because the fever and symptoms like congestion, runny nose and cough disrupt the area in the back of the throat and windpipe, allowing bacteria such as MRSA to enter the bloodstream or lungs, which could cause pneumonia.

Infectious-disease experts warn that the longer-term danger is that MRSA bacteria from the community will come back into the hospital in an even more-resistant form. Because overuse of antibiotics is the main culprit in antibiotic resistance, consumers can help by adhering to the CDC's guidelines for antibiotic use, which caution people to use the drugs only for bacterial infections, not viruses such as cold or flu. Ask health-care providers to wash their hands, and lobby local and state authorities to monitor and enforce infection control in health-care facilities.

By GINA KOLATAPublished: October 30, 2007Clinton T. Rubin knows full well that his recent results are surprising — that no one has been more taken aback than he. And he cautions that it is far too soon to leap to conclusions about humans. But still, he says, what if ... ?

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FAT Abdominal scans of two mice show subcutaneous fat (gray) and visceral fat (red). The vibrated mouse, right, has less of both.

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Less Fat in Vibrated Mice And no wonder, other scientists say. Dr. Rubin, director of the Center for Biotechnology at the State University of New York at Stony Brook, is reporting that in mice, a simple treatment that does not involve drugs appears to be directing cells to turn into bone instead of fat.

All he does is put mice on a platform that buzzes at such a low frequency that some people cannot even feel it. The mice stand there for 15 minutes a day, five days a week. Afterward, they have 27 percent less fat than mice that did not stand on the platform — and correspondingly more bone.

“I was the biggest skeptic in the world,” Dr. Rubin said. “And I sit here and say, ‘This can’t possibly be happening.’ I feel like the credibility of my scientific career is sitting on a razor’s edge between ‘Wow, this is really cool,’ and ‘These people are nuts.’”

The responses to his work bear out that feeling. While some scientists are enthusiastic, others are skeptical.

The mice may be less fat after standing on the platform, these researchers say, but they are not convinced of the explanation — that fat precursor cells are turning into bone.

Even so, the National Institutes of Health is sufficiently intrigued to investigate the effect in a large clinical trial in elderly people, said Joan A. McGowan, a division director at the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Dr. McGowan notes that Dr. Rubin is a respected scientist and that her institute has helped pay for his research for the past 20 years, but she does caution against jumping to conclusions.

“I’d call it provocative,” she said of the new result. “It says, ‘Keep looking here; this is exciting.’ But it is crucial that we don’t oversell this.” For now, she added, “it is a fundamental scientific finding.”

The story of the finding, which was published online and will appear in the Nov. 6 issue of Proceedings of the National Academy of Sciences, began in 1981 when Dr. Rubin and his colleagues started asking why bone is lost in aging and inactivity.

“Bone is notorious for ‘use it or lose it,’” Dr. Rubin said. “Astronauts lose 2 percent of their bone a month. People lose 2 percent a decade after age 35. Then you look at the other side of the equation. Professional tennis players have 35 percent more bone in their playing arm. What is it about mechanical signals that makes Roger Federer’s arm so big?”

At first, he assumed that the exercise effect came from a forceful impact — the pounding on the leg bones as a runner’s feet hit the ground or the blow to the bones in a tennis player’s arm with every strike of the ball. But Dr. Rubin was trained as a biomechanical engineer, and that led him to consider other possibilities. Large signals can actually be counterproductive, he said, adding: “If I scream at you over the phone, you don’t hear me better. If I shine a bright light in your eyes, you don’t see better.”

Over the years, he and his colleagues discovered that high-magnitude signals, like the ones created by the impact as foot hits pavement, were not the predominant signals affecting bone. Instead, bone responded to signals that were high in frequency but low in magnitude, more like a buzzing than a pounding.

That makes sense, he went on, because muscles quiver when they contract, and that quivering is the predominant signal to bones. It occurs when people stand still, for example, and their muscles contract to keep them upright. As people age, they lose many of those postural muscles, making them less able to balance, more apt to fall and, perhaps, prone to loss of bone.

He discovered that in mice, sheep and turkeys, at least, standing on a flat vibrating plate led to bone growth. Small studies in humans — children with cerebral palsy who could not move much on their own and young women with low bone density — indicated that the vibrations might build bone in people, too.

Dr. Rubin and his colleagues got a patent and formed a company to make the vibrating plates. But they and others caution that it is not known if standing on them strengthens bones in humans. Even if it does, no one knows the right dose. It is possible that even if there is an effect, people might overdose and make their bones worse instead of better.

Some answers may come from the federal clinical trial, which will include 200 elderly people in assisted living. It is being directed by Dr. Douglas P. Kiel, an osteoporosis researcher and director of medical research at the Institute for Aging Research at Harvard. The animal work made him hopeful that the buzzing platforms would have an effect on human bones.

“This work is fascinating and very legitimate,” Dr. Kiel said.

But then Dr. Rubin reported that the mice were also less fat, which led to the revised plans to look for changes in body fat as well.

Dr. Rubin says he decided to look at whether vibrations affect fat because he knows what happens with age: bone marrow fills with fat. In osteoporosis, the bones do not merely thin; their texture becomes lacy, and inside the holes is fat. And a few years ago, scientists discovered a stem cell in bone marrow that can turn into either fat or bone, depending on what signal it receives.

No one knows why the fat is in bone marrow — maybe it provides energy for failing bone cells, suggests Dr. Clifford J. Rosen, director of the Maine Center for Osteoporosis Research and Education. And no one knows whether human fat cells ever leave the bone marrow and take up residence elsewhere.

But Dr. Rubin had an idea. “We thought, Wait a second,” he said. “If we are mechanically stimulating cells to form bone, what isn’t happening? We thought maybe these bone progenitor cells are driving down a decision path. Maybe they are not becoming fat cells.”

He paid a visit to Jeffrey E. Pessin, a diabetes expert at Stony Brook, and presented his hypothesis. Dr. Pessin laughed uproariously. He “almost kicked me out of his office,” as Dr. Rubin put it.

But when Dr. Rubin decided to go ahead anyway, Dr. Pessin joined in. Their hope was to see a small effect on body fat after the mice stood on the platforms 15 minutes a day, 5 days a week, for 15 weeks. Dr. Rubin was stunned by the 27 percent reduction.

“Talk about your jaw dropping,” he said.

Some obesity researchers, though, say there may be other reasons that the mice were less fat.

“It is a very intriguing paper,” said Claude Bouchard, an obesity researcher who is director of the Pennington Center for Biomedical Research at Louisiana State University. But he wondered whether the mice on the platform were simply burning more calories.

“It seems to me,” Dr. Bouchard said, “that putting myself in the body of a mouse, if I was on a platform that was vibrating 90 times a minute, I would try to adhere to the surface and not be thrown off. I would probably tense my legs a little bit. That is energy expenditure.”

Stress may be another factor, he added. Standing on the platform may have frightened the mice, and they might have become sick.

Dr. Rudolph L. Leibel, an obesity researcher who is co-director of the Naomi Berrie Diabetes Center at Columbia University, had similar questions.

A platform that seems to be barely vibrating to a human could feel like an earthquake to a mouse, Dr. Leibel said, adding, “they could be scared to death,” which could affect the study data.

He also questioned the idea that precursor cells from bone marrow could turn into fat cells in the rest of the body, calling it “a contested and, I would say, incorrect notion.”

If the mice that stood on the platform became thinner and if they ate as much as mice that did not stand on the platform (as Dr. Rubin reported), they must be burning more calories, Dr. Leibel said.

Others are more hopeful.

“This is very, very cool,” said Dr. John B. Buse, a diabetes researcher at the University of North Carolina who is president for science and medicine at the American Diabetes Association. If it turned out to hold for people too, “it would be great for diabetes,” he added. He noted that people with Type 2 diabetes were likely not only to be overweight but also to have problems with their bones.

ScienceDaily (Nov. 2, 2007) — Physicists in Arizona State University have designed a revolutionary laser technique which can destroy viruses and bacteria such as AIDS without damaging human cells and may also help reduce the spread of hospital infections such as MRSA.

The research, published on Thursday November 1 in the Institute of Physics' Journal of Physics: Condensed Matter, discusses how pulses from an infrared laser can be fine-tuned to discriminate between problem microorganisms and human cells.

Current laser treatments such as UV are indiscriminate and can cause ageing of the skin, damage to the DNA or, at worst, skin cancer, and are far from 100 per cent effective.Femtosecond laser pulses, through a process called Impulsive Stimulated Raman Scattering (ISRS), produces lethal vibrations in the protein coat of microorganisms, thereby destroying them. The effect of the vibrations is similar to that of high-pitched noise shattering glass.

The physicists in Arizona have undertaken experiments to show that the coherent vibrations excited by infrared lasers with carefully selected wavelengths and pulse widths do no damage to human cells, most likely because of the different structural compositions in the protein coats of human cells vis a vis bacteria and viruses.

Professor K. T. Tsen from Arizona State University said, "Although it is not clear at the moment why there is a large difference in laser intensity for inactivation between human cells and microorganisms such as bacteria and viruses, the research so far suggests that ISRS will be ready for use in disinfection and could provide treatments against some of the worst, often drug-resistant, bacterial and viral pathogens."

Femtosecond lasers could find immediate application in hospitals as a way to disinfect blood supply or biomaterials and for the treatment of blood-borne diseases such as AIDS and Hepatitis.

Out With the Trans Fats,In With a Whole Lot of OthersBy JULIE JARGONNovember 6, 2007; Page D1

Food companies are scrambling to replace trans fat in everything from french fries to cookies, but health experts worry that what's good for the nation's heart might be bad for its waistline.

Read more about different kinds of fats Trans fat is created when hydrogen is added to vegetable oil. The resulting ingredient, known as partially hydrogenated vegetable oil, is what makes french fries crispy and croissants flaky. But trans fat's effect on cholesterol -- it raises the bad kind and lowers the good -- has made it a food-industry villain.

Ever since the Food and Drug Administration required food companies to disclose the amount of trans fat in their products last year, the industry has been searching for replacement ingredients. Kraft Foods Inc., the world's second-largest food manufacturer by revenue, has removed trans fat from numerous products, including Oreo cookies, Wheat Thins crackers and Jell-O pudding snacks. PepsiCo's Frito-Lay has eliminated trans fat from all of its chips.

So what's going in food instead of trans fat? Some food makers are going back to ingredients high in cholesterol-raising saturated fat, such as palm oil, palm kernel oil and coconut oil. In Kellogg's Eggo blueberry waffles, for example, trans fats have been replaced with palm oil and palm kernel oil, while Oreos now contain "palm oil and/or canola oil."

Kraft says that while the saturated fat content of Oreos is higher, the overall fat content is the same, at 7 grams per serving. "The effort wasn't just about removing trans fat, but about keeping the nutrition profile the same," says spokeswoman Laurie Guzzinati.

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• A Look at Trans-Fat ReplacementsThuy-An Wilkins, a spokeswoman for Kellogg, says the company has removed the trans fat in most of its products without increasing the amount of saturated fat, but it's still "a work in progress."

Other products are achieving trans-fat-free status through interesterification, a process in which fatty acids are redistributed on a fat molecule to make liquid fats behave more like solid fats. Products made with interesterified fat include Promise Buttery Spread and Enova cooking oil. Unilever, the maker of Promise, conducted its own study 10 years ago that found no adverse effects from food made with interesterified fat, says Doug Balentine, Unilever's director of nutrition sciences for the Americas.

But other nutrition experts say not enough is known about the safety of interesterified fat. There was little interest in researching the ingredient until the recent push for trans-fat alternatives. David Baer, a research physiologist at the U.S. Department of Agriculture's Beltsville Human Nutrition Research Center, says his own research has studied only blended fats, and offers no insights on interesterified fats specifically. "We're interested in trying to figure out the health effects," he says. "The nutrition community is puzzled by what might be the most healthful alternative to trans fat."

K.C. Hayes, director of the Foster Biomedical Research Lab at Brandeis University, says that while the ingredient is in relatively few products now, its use may grow before the health-care community fully understands its impact. Dr. Hayes, who conducted a small study funded by the palm-oil industry that did find negative health effects from interesterified fats, says, "The point is, we should know more before we go off trans fat and onto something else."

The American Heart Association recommends replacing trans fat with monounsaturated fats, which are found in olive, canola, peanut and sunflower oils, or with the polyunsaturated fats found in soybean, corn and safflower oils. For instance, a lot of the chicken sold at KFC is now fried in a type of soybean oil, and McDonald's in the U.S. is switching to a proprietary blend of canola, soybean and corn oils for its french fries.

The biggest danger of the trans-fat swap-out could be that consumers will eat more junk food because they think it's healthier. For one thing, zero doesn't necessarily mean zero. Products can still have up to half a gram of trans fat and carry a "zero trans fat per serving" label. So if someone eats more than a serving of cookies, they could still be consuming a few grams of trans fat.

For years health authorities have warned of the growing threat posed by drug-resistant bacteria, but most of us have been half-listening. Not anymore.A virulent strain of bacteria that resists many antibiotics appears to be killing more people annually than AIDS, emphysema or homicide, taking an estimated 19,000 lives in 2005, according to a study published last week in the Journal of the American Medical Association. The recent death of a 17-year-old high school football player in Virginia is a tragic reminder that methicillin-resistant Staphylococcus aureus, or MRSA, can prey on otherwise healthy people.The best defense against the potentially deadly infection is common sense and cleanliness. “We need to reinvent hygiene for the 21st century,’’ said Dr. Charles Gerba, professor of environmental microbiology at the University of Arizona at Tucson. “You go to a grocery store, and hundreds of thousands of people have touched those surfaces every day. Microorganisms are evolving very rapidly.’’Here are answers to common questions about community-acquired staph infections, or CA-MRSA.What does CA-MRSA look like?CA-MRSA is primarily a skin infection. It often resembles a pimple, boil or spider bite, but it quickly worsens into an abscess or pus-filled blister or sore. Patients who have sores that won’t heal or are filled with pus should see a doctor and ask to be tested for staph infection. They should not squeeze the sore or try to drain it — that can spread the infection to other parts of the skin or deeper into the body. Who is at risk?The vast majority of MRSA cases happen in hospital settings, but 10 percent to 15 percent occur in the community at large among otherwise healthy people. Infections often occur among people who are prone to cuts and scrapes, such as children and athletes. MRSA typically spreads by skin-to-skin contact, crowded conditions and the sharing of contaminated personal items. Others who should be watchful: people who have regular contact with health care workers, those who have recently taken such antibiotics as fluoroquinolones or cephalosporin, homosexual men, military recruits and prisoners. Clusters of infections have appeared in certain ethnic groups, including Pacific Islanders, Alaskan Natives and Native Americans. What can I do to lower my risk of contracting MRSA?Bathing regularly and washing hands before meals is just a start. Wash your hands often or use an antibacterial sanitizer after you’ve been in public places or have touched handrails and other highly trafficked surfaces. Make sure cuts and scrapes are bandaged until they heal. Wash towels and sheets regularly, preferably in hot water, and leave clothes in the dryer until they are completely dry. “Staph is a pretty hardy organism,’’ said Dr. Gerba.Remind kids and teenagers that personal items shouldn’t be shared with their friends, he added. This includes brushes, combs, razors, towels, makeup and cell phones. A teenager in Dr. Gerba’s own family once contracted MRSA, he said, and he eventually traced the bacteria to her cell phone. She had shared it with a friend whose mother worked in a nursing home. Dr. Gerba went on to discover MRSA on the friend’s cell phone and makeup compact and on a countertop in her home.

Where does MRSA lurk?Staph bacteria may be found on the skin and in the noses of nearly 30 percent of the population without causing harm. Experts believe it survives on surfaces in 2 percent to 3 percent of homes, cars and public places. But the bacteria are evolving, and the statistics may already underestimate the prevalence of MRSA. Be especially vigilant in health clubs and gyms — staph grows rapidly in warm, moist environments. The risks of infection and necessary precautions should be explained to student athletes, particularly those in contact sports who often suffer cuts and spend time in locker rooms. When working out at the gym, make sure you wipe down equipment before you use it. Many people clean just the sweaty benches, but Dr. Gerba notes that MRSA also has been found on the grips of workout machines. And if you have a scrape or sore, keep it clean and bandaged until it heals. Minor cuts and scrapes are the way MRSA takes hold. What is the single best thing I can do to protect myself from MRSA?Without question, people need to show far more respect for antibiotics. Misuse of antibiotics allows bacteria to evolve and develop resistance to drugs. But parents often pressure pediatricians to prescribe antibiotics even when they don’t help the vast majority of childhood infections. When you do take an antibiotic, finish the dose. Antibiotic resistance is bad for everyone, but your body can also become particularly vulnerable to resistant bacteria if you are careless with the drugs.How do I find out more?One of the most useful Web sites is a MRSA primer from Mayoclinic.com. The Centers for Disease Control and Prevention offers a useful Q&A about MRSA in schools. A patient website called MRSA Resources lists a few stories of patients affected by MSRA. Recent Stanford University grad Nick Yee chronicles his struggle with MRSA on his Web site, which includes graphic videos of his wound and treatment. (I couldn’t get through them.) And if you have the stomach for it, a number of people have — inexplicably — posted videos of their MRSA wounds on YouTube.

Vaccines against measles, mumps and tetanus can fight off diseases for decades, says a study that questions whether Americans need booster shots with the frequency they currently are being given.

In the study, published in the New England Journal of Medicine, researchers at Oregon Health & Science University in Beaverton said they found surprisingly high levels of disease-resisting antibodies in the blood of patients who had been vaccinated years earlier. Vaccines prompt antibody creation by giving patients a small dose of the virus that creates the disease.

The persistence of the antibodies suggests that current recommendations for booster shots for some common conditions could be revised, the study said. For instance, Mark K. Slifka, one of the study's authors, said that tetanus shots could be given once approximately every 30 years instead of once every 10 years, as currently is recommended.

The study found that protection from conditions such as measles, mumps and rubella following exposure to the diseases were, in most cases, maintained for life.

Although it isn't dangerous to get booster shots, the study's authors said it may be unnecessary in some circumstances. "If we can continue to improve our vaccines, someday we might be able to give one shot and give lifelong immunity," said Mr. Slifka, associate professor at the Oregon university's Vaccine and Gene Therapy Institute.

John Treanor, a physician specializing in infectious diseases at the University of Rochester in New York state, said that before the health-care system eliminates boosters, more study is needed on outbreaks of certain diseases and declining vaccine efficacy. "I think this is helpful and great to have," he said, referring to the study. "I don't know if this is so definitive."

The researchers said that the efficacy of vaccines doesn't apply across the board: children frequently need chickenpox booster shots after five years because the vaccine antibodies aren't as potent as the antibodies created by the disease itself, Mr. Slifka noted.

The researchers analyzed 630 stored blood samples from 45 patients. With each sample, the authors analyzed the decay rate for antibodies from vaccines for measles, mumps, rubella, varicella-zoster virus, and Epstein-Barr, the herpes virus that causes mononucleosis.

CT scans have long been cited as a prime example of how the overuse of fancy medical technologies can drive up the cost of health care. Now there are newly voiced concerns that computed tomography, or CT, may be a health risk as well.

The scans, which were introduced in the 1970s, have revolutionized medical imaging by producing three-dimensional views of organs and other tissues. The scans are undeniably of great value in helping doctors diagnose just what is causing a patient’s illness or pain. But a critique published in The New England Journal of Medicine by two researchers at Columbia University’s Center for Radiological Research warns that usage has spread so rapidly that high, lifetime doses of radiation are now becoming a pubic health hazard.

More than 62 million CT scans were performed in the United States last year, a huge increase from the 3 million performed in 1980. And each scan gives the patient a far higher dose of radiation than a conventional X-ray would. Unfortunately, even many doctors have no idea how much radiation a CT scan delivers.

The risk that a single CT scan might cause cancer is very small, and the medical benefits of diagnosing an ailment far outweigh the slight radiation risk. The problem comes when CT scans are not medically appropriate, such as full-body scans to screen patients who feel fine on the chance that some hidden disease might be detected, or when CT scans are repeated again and again as patients traipse from one doctor to another while their medical records lag behind.

The researchers cite previous estimates that a third of all CT scans performed in the United States could be replaced with less risky diagnostic technologies or not performed at all. If true, that means that some 20 million adults and 1 million children in this country are being irradiated unnecessarily each year. In coming decades, the researchers suggest, as many as 2 percent of all cancers in the United States may be because of radiation from CT scans performed today.

Even if these predictions are on the high side, as some radiologists and medical device manufacturers contend, the message for patients and their doctors is clear: Restrict the use of CT scans to cases where they can truly aid in diagnosis and consider other options, such as ultrasound or magnetic resonance imaging, which have no radiation risk.

If you look at the 1809 picture of the 700 pound man one sees something that is becoming common. Even in my 25 years in medicine seeing patients over 300 or 400 pounds was not common. Now it is very common. We need better treatments for obesity and I await better pharmacologics for this; I've heard Merck is working on one but I have no further information on it. It was a big disappointment that rimonabant from Sanofi did not get yet approved here (it is in Europe) since that would have helped. Anyone know people in Europe who have used it?

What I was trying to ask, apparently too laconically, is that why does one need drugs to lose weight?

Anyway, what do you think of this?=======================

The Dangers of High Fructose Corn SyrupBy John Mericle M.D.

High Fructose Corn SyrupBefore we get to high fructose corn syrup (HFCS), we will take a look at two other frequently used sweeteners, dextrose and maltodextrin.

DextroseDextrose is more or less an industry term for glucose. Glucose isthe most prevalent sugar in the human and the only molecule that the brain can metabolize. Dextrose is refined from corn starch. It has a very high glycemic index (no surprise since it is glucose) and while it contains no fructose, it is still a simple sugar that is very readily absorbed. It is not as dangerous as sucrose but it still is a highly processed product that should be avoided.

MaltodextrinMaltodextrin is also a refined product usually made from either corn or potatoes. It is multiple glucose units somewhat loosely hooked together (a polymer). Because the bonds between the glucose units are very weak, it is also very readily absorbed and has a very high glycemic index. Like dextrose it should be avoided as much as possible. It has been called a "sugar substitute"but that is based on a rather strict definition of sugar as "sucrose." It is a very common additive and I have found it in many packaged foods, including potato chips.

High Fructose Corn SyrupHigh fructose corn syrup is made by treating corn (which is usually genetically modified corn) with a variety of enzymes, some of which are also genetically modified, to first extract the sugar glucose and then convert some of it into fructose, since fructose tastes sweeter than glucose. The end result is a mixture of 55% fructose and 45% glucose, that is called "high fructose corn syrup." Improvements in production occurred in the 1980's making it cheaper than most other sweeteners. I remember in the 1980's when the price of Pepsi dropped from about $3 for a sixpack to about $1.50. In 1966 refined sugar such as sucrose was the was the leading sweetener / additive. In 2001 corn sweeteners accounted for 55% of the sweetener market. Consumption of high fructose corn syrup went from zero in 1966 to 62.6 pounds per person in 2001. A 12 ounce soda can contain as much as 13 teaspoons of sugar in the form of high fructose corn syrup.Once again, the dangerous combination: fructose and glucose.When high fructose corn syrup breaks down in the intestine, we once again find near equal amounts of glucose and fructose entering the bloodstream. As covered in recent newsletters, the fructose short-circuits the glycolytic pathway for glucose. This leads to all the problems associated with sucrose. In addition, HFCS seems to be generating a few of its own problems, epidemic obesity being one of them. Fructose does not stimulate insulin production and also fails to increase "leptin" production, a hormone produced by the body's fat cells. Both of these act to turn off the appetite and control body weight. Also, fructose does not suppress ghrelin, a hormone that works to increase hunger. This interesting work is being done by Peter Havel at UC Davis.

Some of the problems associated with high fructose corn syrup:Increased LDL's (the bad lipoprotein) leading to increased risk of heart disease.Altered Magnesium balance leading to increased osteoporosis.Increased risk of Adult Onset Diabetes Mellitus.Fructose has no enzymes or vitamins thus robbing the body of precious micro-nutrients.Fructose interacts with birth control pills and can elevate insulin levels in women on the pill.Accelerated aging.Fructose inhibits copper metabolism leading to a deficiency of copper, which can cause increased bone fragility, anemia, ischemic heart disease and defective connective tissue formation among others.

The list below is from The San Francisco Chronicle February 18, 2004

"How much is too much?

The list below shows how much sugar, mostly in the form of high fructose corn syrup, is in each of these single servings.

I agree with the poor nutrional value of a lot of the high simple sugars we eat, but that does not get to the problem of obesity.

I plan on taking extra training in bariatric medicine over the next few months and will share here but I believe this theory accounts for the extreme difficulty for overweight people to lose weight and keep it off:

People who lose weight actually start to experience the same discomforts (if you will) that people who experience starvation experience. Eventually their every thought turns to getting more food. It becomes uncontrollable and overwhelming. Eventually most people give in and start eating again. The reward is not just the taste of food, but relief from the unbearably uncomfortable sensations one feels when your body thinks your starving - even though you are overweight.

Body has two supplies of energy: glycogen and fat. When our body's hormones e.g. insulin are "in the zone" we burn both, but when we eat high glcemic foods we burn glycogen, but not fat. Brain requires glycogen, hence when we run low the body'd demand for fuel becomes irresistable. Over time weight ratchets upwards. But if we maitain hormonal balance by eating correct mix of carbs (low glycemic) protein and fat, then body burns fat as well as glycogen. Thus glycogen stores last longer before brain/body insists on more fuel and fat weight can truly be lost.

I hope I have explained this coherently and accurately, but guarantee neither

A study carried out in San Francisco and Boston, USA, found that sexually active gay men were many times more likely to acquire a new highly antibiotic-resistant strain of the MRSA superbug than the rest of the population.

The study is published in the January 15th early online issue of the Annals of Internal Medicine and was led by researchers at the University of California, San Francisco (UCSF).

Scientists have noticed that infection with the multidrug-resistant, community associated methicillin-resistant Staphylococcus aureus (MRSA) appears to occur in isolated pockets.

The new strain, called USA300, which is resistant to many more front line antibiotics, is a close relative of the MRSA strain that has begun to spread outside of hospitals and into the community in recent years (CA-MRSA, or community associated MRSA, but technically also known as USA300).

Both strains spread easily through skin to skin contact, and get into the skin and the underlying tissue, causing abscesses and ulcers that can become life-threatening quite quickly.

The UCSF researchers decided to investigate the risk factors for infection with the new USA300, which has gained a foothold in San Francisco and other US cities.

The study was in two parts: a population-based survey of 9 San Francisco hospitals and a cross-sectional study in 2 outpatient clinics in San Francisco and Boston. The data reviewed related to culture proven cases of MRSA infections spanning 2004 to 2006.

The strain of MRSA in the samples were identified using a range of methods such as: DNA sequencing (establishing the pattern of nucleotides in the DNA), polymerase chain reaction assays (amplifying DNA to help identify it), and pulse field gel electrophoresis (looking at very large DNA molecules).

The results for San Francisco showed that: The overall incidence of USA300 infection in San Francisco was 26 cases per 100,000 of the population (ranging from 16 to 36).

The incidence was higher in 8 adjacent neighbourhoods (identified by ZIP codes) that had a higher proportion of male same-sex couples.

Men who have sex with men were 13 times more likely to be infected with USA300.

This risk was independent of previous history of MRSA infection or use of clindamycin (an antibiotic used to treat MRSA).

The risk also appeared to be independent of HIV infection.

USA300 infection mostly occurred in the buttocks, genitals, or perineum (the area between the anus and the penis). The results for Boston showed that multi-drug resistant USA300 strains were recovered only from men who have sex with men.

The study concluded that:

"Infection with multidrug-resistant USA300 MRSA is common among men who have sex with men, and multidrug-resistant MRSA infection might be sexually transmitted in this population."

In a separate press statement, the researchers expressed their concern that the new MRSA strain could soon spread to the general population. It can be spread through skin to skin contact but appears to be trasmitted more easily through intimate sexual contact, they said.

Lead author of the study, Dr Binh Diep, who is a UCSF postdoctoral scientist at San Francisco General Hospital Medical Center, said:

"These multi-drug resistant infections often affect gay men at body sites in which skin-to-skin contact occurs during sexual activities."

"But because the bacteria can be spread by more casual contact, we are also very concerned about a potential spread of this strain into the general population," he added.

He explained that the most effective way to protect oneself against infection, especially after sex, was to scrub the skin well with soap and water.

Diep said he was alarmed by the rapid rise in infections. In the figures they collected, they found that San Francisco's Castro district, which has the highest proportion of gays in the country, the infection rate of MRSA was around 1 in 588 people. This compares with about 1 in 3,800 for the overall population of San Francisco, which is also high, said Diep.

Co-author Dr Henry Chambers, who is UCSF professor of medicine at San Francisco General Hospital Medical Center and lead scientist of a large multi-centered clinical trial recently funded by the National Institute of Health to study treatment of community-associated MRSA infections, said:

"Prompt diagnosis and the right treatment are crucial to prevent life-threatening infections and the spread of this bacteria to close contacts."

The authors pointed out that their study was limited by the fact it was retrospective, and they had not looked at the link between sexual risk behaviours and infection. They recommended that:

"Further research is needed to determine whether existing efforts to control epidemics of other sexually transmitted infections can control spread of community-associated multidrug-resistant MRSA."

Diabetes Study Partially Halted After Deaths E-MailPrint Reprints Save ShareDel.icio.usDiggFacebookNewsvinePermalinkBy GINA KOLATAPublished: February 7, 2008For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.

The researchers announced that they were abruptly halting that part of the study, whose surprising results call into question how the disease, which affects 21 million Americans, should be managed.

The study’s investigators emphasized that patients should still consult with their doctors before considering changing their medications.

Among the study participants who were randomly assigned to get their blood sugar levels to nearly normal, there were 54 more deaths than in the group whose levels were less rigidly controlled. The patients were in the study for an average of four years when investigators called a halt to the intensive blood sugar lowering and put all of them on the less intense regimen.

The results do not mean blood sugar is meaningless. Lowered blood sugar can protect against kidney disease, blindness and amputations, but the findings inject an element of uncertainty into what has been dogma — that the lower the blood sugar the better and that lowering blood sugar levels to normal saves lives.

Medical experts were stunned.

“It’s confusing and disturbing that this happened,” said Dr. James Dove, president of the American College of Cardiology. “For 50 years, we’ve talked about getting blood sugar very low. Everything in the literature would suggest this is the right thing to do,” he added.

Dr. Irl Hirsch, a diabetes researcher at the University of Washington, said the study’s results would be hard to explain to some patients who have spent years and made an enormous effort, through diet and medication, getting and keeping their blood sugar down. They will not want to relax their vigilance, he said.

“It will be similar to what many women felt when they heard the news about estrogen,” Dr. Hirsch said. “Telling these patients to get their blood sugar up will be very difficult.”

Dr. Hirsch added that organizations like the American Diabetes Association would be in a quandary. Its guidelines call for blood sugar targets as close to normal as possible.

And some insurance companies pay doctors extra if their diabetic patients get their levels very low.

The low-blood sugar hypothesis was so entrenched that when the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases proposed the study in the 1990s, they explained that it would be ethical. Even though most people assumed that lower blood sugar was better, no one had rigorously tested the idea. So the study would ask if very low blood sugar levels in people with Type 2 diabetes — the form that affects 95 percent of people with the disease — would protect against heart disease and save lives.

Some said that the study, even if ethical, would be impossible. They doubted that participants — whose average age was 62, who had had diabetes for about 10 years, who had higher than average blood sugar levels, and who also had heart disease or had other conditions, like high blood pressure and high cholesterol, that placed them at additional risk of heart disease — would ever achieve such low blood sugar levels.

Study patients were randomly assigned to one of three types of treatments: one comparing intensity of blood sugar control; another comparing intensity of cholesterol control; and the third comparing intensity of blood pressure control. The cholesterol and blood pressure parts of the study are continuing.

Dr. John Buse, the vice-chairman of the study’s steering committee and the president of medicine and science at the American Diabetes Association, described what was required to get blood sugar levels low, as measured by a protein, hemoglobin A1C, which was supposed to be at 6 percent or less.

“Many were taking four or five shots of insulin a day,” he said. “Some were using insulin pumps. Some were monitoring their blood sugar seven or eight times a day.”

They also took pills to lower their blood sugar, in addition to the pills they took for other medical conditions and to lower their blood pressure and cholesterol. They also came to a medical clinic every two months and had frequent telephone conversations with clinic staff.

Those assigned to the less stringent blood sugar control, an A1C level of 7.0 to 7.9 percent, had an easier time of it. They measured their blood sugar once or twice a day, went to the clinic every four months and took fewer drugs or lower doses.

So it was quite a surprise when the patients who had worked so hard to get their blood sugar low had a significantly higher death rate, the study investigators said.

The researchers asked whether there were any drugs or drug combinations that might have been to blame. They found none, said Dr. Denise G. Simons-Morton, a project officer for the study at the National Heart, Lung and Blood Institute. Even the drug Avandia, suspected of increasing the risk of heart attacks in diabetes, did not appear to contribute to the increased death rate.

Nor was there an unusual cause of death in the intensively treated group, Dr. Simons-Morton said. Most of the deaths in both groups were from heart attacks, she added.

For now, the reasons for the higher death rate are up for speculation. Clearly, people without diabetes are different from people who have diabetes and get their blood sugar low.

It might be that patients suffered unintended consequences from taking so many drugs, which might interact in unexpected ways, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic.

Or it may be that participants reduced their blood sugar too fast, Dr. Hirsch said. Years ago, researchers discovered that lowering blood sugar very quickly in diabetes could actually worsen blood vessel disease in the eyes, he said. But reducing levels more slowly protected those blood vessels.

And there are troubling questions about what the study means for people who are younger and who do not have cardiovascular disease. Should they forgo the low blood sugar targets?

No one knows.

Other medical experts say that they will be discussing and debating the results for some time.

“It is a great study and very well run,” Dr. Dove said. “And it certainly had the right principles behind it.”

But maybe, he said, “there may be some scientific principles that don’t hold water in a diabetic population.”

No Answers for Men With Prostate CancerNY TimesLast year, 218,000 men were diagnosed with prostate cancer, but nobody can tell them what type of treatment is most likely to save their life.Those are the findings of a troubling new report from the Agency for Healthcare Research and Quality, which analyzed hundreds of studies in an effort to advise men about the best treatments for prostate cancer. The report compared the effectiveness and risks of eight prostate cancer treatments, ranging from prostate removal to radioactive implants to no treatment at all. None of the studies provided definitive answers. Surprisingly, no treatment emerged as superior to doing nothing at all.“When it comes to prostate cancer, we have much to learn about which treatments work best,'’ said agency director Carolyn M. Clancy. “Patients should be informed about the benefits and harms of treatment options.”But the study, published online in the Annals of Internal Medicine, gives men very little guidance. Prostate cancer is typically a slow-growing cancer, and many men can live with it for years, often dying of another cause. But some men have aggressive prostate cancers, and last year 27,050 men died from the disease. The lifetime risk of being diagnosed with prostate cancer has nearly doubled to 20 percent since the late 1980s, due mostly to expanded use of the prostate-specific antigen, or P.S.A., blood test. But the risk of dying of prostate cancer remains about 3 percent. “Considerable overdetection and overtreatment may exist,'’ an agency press release stated. The agency review is based on analysis of 592 published articles of various treatment strategies. The studies looked at treatments that use rapid freezing and thawing (cryotherapy); minimally invasive surgery (laparoscopic or robotic-assisted radical prostatectomy); testicle removal or hormone therapy (androgen deprivation therapy); and high-intensity ultrasound or radiation therapy. The study also evaluated research on “watchful waiting,'’ which means monitoring the cancer and initiating treatment only if it appears the disease is progressing.No one treatment emerged as the best option for prolonging life. And it was impossible to determine whether one treatment had fewer or less severe side effects.Many of the treatments now in widespread use have never been evaluated in randomized controlled trials. In the research that is available, the characteristics of the men studied varied widely. And investigators used different definitions and methods, making reliable comparisons across studies impossible. “Investigators’ definitions of adverse events and criteria to define event severity varied widely,'’ the report notes. “We could not derive precise estimates of specific adverse events for each treatment.'’The report findings highlighted by the agency include:All active treatments cause health problems, primarily urinary incontinence, bowel problems and erectile dysfunction. The chances of bowel problems or sexual dysfunction are similar for surgery and external radiation. Leaking of urine is at least six times more likely among surgery patients than those treated by external radiation. Urinary leakage that occurs daily or more often was more common in men undergoing radical prostatectomy (35 percent) than external-beam radiation therapy (12 percent) or androgen deprivation (11 percent). Those were the findings of the 2003 Prostate Cancer Outcomes Study, a large, nationally representative survey of men with early prostate cancer. External-beam radiation therapy and androgen deprivation were each associated with a higher frequency of bowel urgency (3 percent) compared with radical prostatectomy (1 percent), according to the 2003 report. Inability to attain an erection was higher in men undergoing active intervention, especially androgen deprivation (86 percent) or radical prostatectomy (58 percent) than in men receiving watchful waiting (33 percent), according to the 2003 report. One study showed that men who choose surgery over watchful waiting are less likely to die or have their cancer spread, but another study found no difference in survival between surgery and watchful waiting. The benefit, if any, appears to be limited to men under 65. However, few patients in the study had cancer detected through P.S.A. tests. As a result, it’s not clear if the results are applicable to the majority of men diagnosed with the disease. Adding hormone therapy prior to prostate removal does not improve survival or decrease recurrence rates, but it does increase the chance of adverse events. Combining radiation with hormone therapy may decrease mortality. But compared with radiation treatment alone, the combination increases the chances of impotence and abnormal breast development. The most obvious trend identified in the complicated report is how little quality research exists for prostate cancer, despite the fact that it is the most diagnosed cancer in the country.Studies comparing brachytherapy, radical prostatectomy, external-beam radiation therapy or cryotherapy were discontinued because of poor recruitment. Two ongoing trials, one in the United States and one in Britain, are evaluating surgery and radiation treatments compared with watchful waiting in men with early cancer. Other studies in progress or development include cryotherapy versus external-beam radiation and a trial evaluating radical prostatectomy versus watchful waiting. “Successful completion of these studies is needed to provide accurate assessment of the comparative effectiveness and harms of therapies for localized prostate cancers,” the study authors said.

Your article is correct in pointing out some confusion with regard to treating prostate cancer. Screening for prostate cancer is also with controversy. A few experts are starting to wonder if we should do away with the screening blood test - PSA- altogether. This after some published reports that we should use 2.5 as the "normal" rather than the higher, less strict 4 which has been used for around 15 years or so.

When talking to patients who have never had a psa I try to point out the controversy in interpretation of the PSA. I still recommend it. One reasonable rec is to offer it to men whose life expectancy is at least 10 years.

Speaking of confusion in medicine there was a study that just came out saying that calcium supplements may increase the risk for heart attacks in women taking it for the bones. Ughhhh!!!

It's simple: Employ these scientific strategies now and add years of good living to your future

By: Denny Watkins & Alison Granell & Heather Loeb

We've been told that the only sure things are death and taxes. But just as creative accountants have helped many men triumph over their 1040s, we can help you outrun the reaper. Maybe it's a game you can't ultimately win. But by following these 50 tips, you sure as hell can send it into overtime.

1. Drink at Least Five 8-ounce Glasses of Water a Day

Scientists at Loma Linda University found that men who drank this amount of H2O were 54 percent less likely to suffer a fatal heart attack than those who drank two glasses or less every day.

Over a 3-year period, men who clocked in despite feeling under the weather had double the heart-attack risk of guys who stayed in bed, according to a U.K. study.

4. Put Out the Fire in Your Chest

Untreated heartburn can lead to a heart attack, according to a study in the International Journal of Cardiology. Scientists discovered that as acid levels in the esophagus rise, the incidence of blocked bloodflow to the heart also rises by 20 percent. A natural remedy: Analyze your diet. Don't make a habit of drinking wine, juice, or carbonated beverages, all of which are highly acidic and may trigger heartburn, say South Carolina researchers.

5. Indulge Your Chocolate Craving

In a 15-year study, Dutch scientists determined that men who ate just 4 grams of cocoa a day had half the risk of dying from heart disease than those who ate less. That's the equivalent of two 25-calorie Hershey's Kisses -- an amount that can fit into any diet.

6. Say No to Froot Loops

In a review of 53 studies, Australian researchers found that regularly eating cereal made from refined grains raises insulin and C-reactive protein, and lowers good cholesterol -- all factors that boost your odds of developing heart disease. A better choice for your morning bowl: Post Shredded Wheat cereal, which is made from 100 percent whole grains and contains no sugar.

7. Take a Magnesium Supplement

Over an 18-year period, French researchers determined that men with the highest blood levels of magnesium are 40 percent less likely to die of any cause than those with the lowest levels. Magnesium can make multivitamins too bulky, so add a 250 milligram (mg) pill from iherb.com or GNC to your daily regimen.

8. Burn 1,100 Calories a Week

Duke University scientists discovered that this amount of exercise prevents the accumulation of visceral adipose tissue -- the dangerous belly fat that causes arterial inflammation and hypertension. Falling short? Join a league: A recent British Medical Journal study reported that people who exercised in groups boosted their average calorie burn by 500 a week.

9. Take a Daily Multivitamin

Researchers at the University of California at Berkeley discovered that this helps prevent the DNA damage that causes cancer. We like Centrum Silver.

10. Hit the Weights

University of Michigan scientists found that men who completed three total-body weight workouts a week for 2 months lowered their diastolic blood pressure (the bottom number) by an average of eight points. That's enough to reduce the risk of stroke by 40 percent and heart attack by 15 percent.

11. Set a Three-Drink Limit

Harvard researchers determined that downing more than three drinks in a 24-hour period increases your risk of atrial fibrillation, a condition that may boost your odds of a stroke fivefold during that time. An important note: When the average man pours himself a glass of wine, it's typically twice the size of a standard drink (4 ounces), report researchers at Duke University.

IF YOU THINK YOU'RE HAVING A HEART ATTACK...

12. Plop an Alka-Seltzer

It contains 325 milligrams of aspirin, the same as a regular aspirin, and begins fighting blood clots almost 3 minutes faster than a pill, according to a study in Thrombosis Research.

13...and Call a Ride

Walk-in patients wait almost twice as long in the E.R. as those who arrive by ambulance, according to a University of New Mexico study.

14. Treat a Killer Bee Sting

You may not know if you're allergic to the venom of a bee, wasp, or hornet until you've already been stung. But if you start to experience the symptoms of a life-threatening reaction--hives, wheezing, abdominal cramping--you can save yourself in 3 steps:

Step 1. Call 911.

Step 2. Take a Benadryl.

Step 3. Lie on your back and elevate your legs while you wait for help, says Steven Kernerman, D.O., an allergist at the Spokane Allergy and Asthma Clinic. An allergic reaction can constrict your blood vessels, and our three-step strategy counteracts that by improving bloodflow to your heart.

15. Eat Produce at Every Meal

If you consume more than five servings of fruits and vegetables per day, you have a 26 percent lower risk of stroke than people who eat fewer than three servings, according to a recent U.K. study.

16. Monitor Your Blood Sugar

Johns Hopkins University researchers recently determined that people with the highest blood-sugar levels have twice the risk of heart disease as those with the lowest. A warning sign: fasting blood sugar that's greater than 100 mg per deciliter.

17. Think Positive

Purdue scientists discovered that constant worrying shortens your life span by 16 years.

18. Keep Your Cool

Men who frequently express anger outwardly are more than twice as likely to have a stroke than guys who control their tempers, according to the journal Stroke. If you have anger-management issues, try fish oil. National Institutes of Health scientists found that hostile, aggressive men often have low blood levels of DHA--one of the main omega-3 fats found in the oil. We like Nordic Naturals Ultimate Omega ($27 for 60 1,000-milligram (mg) softgels; nordicnaturals.com). Take 1,000 to 2,000 mg every day.

MAKE SURE YOU DON'T END UP AS FISH FOOD.

Most shark attacks occur at dawn and dusk, when sharks feed, says Alan Henningsen, a marine biologist and shark researcher at the National Aquarium in Baltimore. You can watch the sky for clues to their location: Seabirds eat the same fish as sharks. Here are three more ways to avoid a grisly death.

19. Dive with a Partner

This cuts the chance of a shark attack by 50 percent, say Australian scientists.

20. If You're Attacked, Hit the Shark in Its Eyes or Gills

These are its most sensitive areas. The snout might work as a target, but this tactic often results in a bitten arm, according to a University of Maryland study.

21. For God's Sake, Don't Pee in the Ocean

Bodily Fluids attract sharks

22. Try a Natural Remedy

According to Israeli scientists, eating one red grapefruit a day lowers LDL (bad) cholesterol by 20 percent, even in people who don't respond to statins.

23. Have Breakfast within 90 Minutes of Waking

A University of Massachusetts study found that men who waited longer than that were 50 percent more likely to become obese. And U.K. researchers determined that increases in body mass were directly proportionate to the likelihood of dying of gut cancers -- specifically rectal, bladder, colon, and liver.

24. Vacuum for 30 Minutes

Doing 150 calories' worth of chores a day can lower high blood pressure by 13 points, according to Medicine & Science in Sports & Exercise. The reduction lasts only 8 hours, but make it a daily habit and you can lower your BP in the long term. (Helping out more with housework may improve your sex life, too.)

25. Eat Berries

The antioxidants in cranberries, blueberries, strawberries, and raspberries have been shown to offer protection from a stroke, keep you mentally sharp as you age, and ward off cancer.

26. Drownproof Yourself

If you're dumped in the water without a life preserver, the key to survival is staying warm and conserving energy. Use the method taught to U.S. Navy pilots: Float facedown in the water with your knees tucked against your chest in the fetal position. (This slows the drop in body temperature.) Exhale bubbles slowly, turning your head to one side only to inhale deeply. Repeat until help arrives.

27. Sleep on Your Side

This can halve the number of sleep-apnea-related wakeups you experience during the night. Such interruptions make you up to six times more likely to be involved in an auto accident, due to residual fatigue, according to researchers at University Hospital in Bern, Switzerland. To keep from rolling over onto your back as you sleep, stuff a small, firm neck pillow down the back of your T-shirt before dozing off.

28. Light a Jasmine-Scented Candle

Men who did this for just 1 minute before bed fell asleep faster, tossed and turned less, and felt more refreshed in the morning than those who didn't inhale the aroma, report scientists at Wheeling Jesuit University. That's important, because insufficient sleep boosts your risk of diabetes, and restless sleep increases your odds of a stroke.

Stay off the toilet during severe thunderstorms. If lightning hits within even 60 feet of your house, it can not only jump through phone and electrical lines but also run through plumbing, according to the National Weather Service.

31. Put Your iPod on a Mount

Reaching for an unsecured object as you drive makes you eight times more likely to swerve into a road barrier, according to the Mayo Clinic.

32. Check Your Smoke Alarms

The most likely reason a house fire ends in a fatality: no early warning. While just about every U.S. residence has smoke alarms, a Morehouse School of Medicine study revealed that the devices were nonfunctioning in one-third of homes due to dead or absent batteries. If you've ever let the juice in any of your detectors dwindle -- or removed the battery simply to disable the low-power beep -- consider installing at least one DuPont self-charging smoke alarm ($26; target.com). It screws into a ceiling light socket and feeds off your home's electricity.

33. Sip on Mint Tea

It contains the powerful antioxidant hesperidin, which reduces the inflammation and oxidative stress associated with diabetes by 52 percent, according to a study at the University of Buffalo. And despite its lack of caffeine, mint tea also increases alertness.

34. Don't Jaywalk

This is particularly good advice if you've had too much to drink, because 77 percent of pedestrians killed while crossing the road aren't at intersections. And 53 percent of those killed at night had blood-alcohol concentrations at or above .08 percent, the legal limit in all 50 states.

35. Don't Get Blown to Bits

Keep bleach, paint stripper, fabric softener, glue, and sidewalk salt away from gas appliances. The chlorine or fluorine in these products breaks down into ionized gas, which can eat holes in the pipes that deliver the fuel for your furnace, range, or dryer. Think you smell fumes? Don't call for help from inside your house; using your phone could create an electric spark and set off an explosion.

People who exercise at any intensity for 2 hours a week--an average of about 17 minutes a day--are 61 percent less likely to feel highly stressed than their sedentary counterparts, according to researchers in Denmark.

37...Then Take it Outside

British researchers found that people who exercised outdoors reduced their depression by 71 percent, while indoor exercisers' depression decreased by only 45 percent after their workouts.

38. Cut Out the Sweet Stuff

Tufts University researchers found that men on low-sugar diets had lower levels of depression and anxiety than those who consumed all types of carbs. The happier people also limited their total carb intake to 40 percent of total calories.

39. Douse Your Salad with Oil and Vinegar

European scientists determined that unheated olive oil reduces cancer risk. As for vinegar, eating it prior to a high-carbohydrate meal (like pasta) slows the absorption of carbs into your bloodstream. This prevents the spikes in blood sugar and insulin that signal your body to store fat.

40. Add Curry to Vegetables

Rutgers University scientists discovered that a combination of turmeric (found in curry powder) and phenethyl isothiocyanate (a compound in broccoli, brussels sprouts, and cauliflower) helps fight prostate cancer. The researchers believe that dusting your vegetables just once a week will provide protection.

41. Be a Career Coach

A man married to a woman who is upset by her work is 2.7 times more likely to develop heart disease. If your wife won't find a new job, help her practice her negotiating skills. A Harvard study found that due to anxiety, women don't initiate money talks at work as often as men do, especially when the boss is male.

42. Stash a Cinnamon Air Freshener in your car

The strong, spicy smell can help you stay alert as you drive. Researchers at Wheeling Jesuit University found that a whiff increases alertness by 25 percent. Sucking on an Altoid may work, too.

43. Test Yourself for HIV

A recent British study confirms that early detection is the key to extending your life. You can order a take-home HIV test online ($44, homeaccess.com), mail in your blood sample, and receive your results in the mail just 7 days later.

44. Fall on Your Butt

If you feel yourself losing balance on the stairs, crouch so that your butt hits first, says Robert Nirschl, M.D., a spokesman for the American Academy of Orthopaedic Surgeons. Don't be afraid to bounce down a few steps -- it'll make a fatal blow less likely.

45. Design a Colorful Menu

Colorado State University scientists discovered that men who eat the widest variety of fruits and vegetables gain greater cancer-fighting benefits than those who eat more total servings but choose from a smaller assortment. That's because the plant chemicals that protect against disease vary between botanical families. Mix it up by choosing one serving from five different color groups: blues and purples, greens, whites, reds, and yellows and oranges.

46. Take a Noontime Nap

Breaking up your day with a 30-minute snooze can reduce coronary mortality by 37 percent, report Greek researchers. Why? It reduces stress that can damage your heart. Even a short nap once or twice a week was found to decrease the risk of early death.

47. Steep Your Tea for at Least 3 Minutes

Any less than that lowers the number of disease-fighting antioxidants.

48. Use Watercress in Your Salad

A study from the American Journal of Clinical Nutrition reveals that eating 3 ounces of watercress every day increases levels of the cancer-fighting anti-oxidants lutein and beta-carotene by 100 and 33 percent, respectively.

49. Enjoy Your Joe

Brooklyn College researchers recently discovered that drinking 4 cups of coffee a day lowers your risk of dying of heart disease by 53 percent. If you like Starbucks, choose a Caffè Americano: A grande counts as 4 cups and contains just 15 calories.

50. Ask for the Heel

Bread crust has up to eight times more pronyl lysine -- an antioxidant that fights cancer -- than what's in the center. Similarly, the skin of produce is loaded with healthy nutrients, too.

Mobile phones could kill far more people than smoking or asbestos, a study by an award-winning cancer expert has concluded. He says people should avoid using them wherever possible and that governments and the mobile phone industry must take "immediate steps" to reduce exposure to their radiation.

The study, by Dr Vini Khurana, is the most devastating indictment yet published of the health risks.

It draws on growing evidence – exclusively reported in the IoS in October – that using handsets for 10 years or more can double the risk of brain cancer. Cancers take at least a decade to develop, invalidating official safety assurances based on earlier studies which included few, if any, people who had used the phones for that long.

Earlier this year, the French government warned against the use of mobile phones, especially by children. Germany also advises its people to minimise handset use, and the European Environment Agency has called for exposures to be reduced.

Professor Khurana – a top neurosurgeon who has received 14 awards over the past 16 years, has published more than three dozen scientific papers – reviewed more than 100 studies on the effects of mobile phones. He has put the results on a brain surgery website, and a paper based on the research is currently being peer-reviewed for publication in a scientific journal.

He admits that mobiles can save lives in emergencies, but concludes that "there is a significant and increasing body of evidence for a link between mobile phone usage and certain brain tumours". He believes this will be "definitively proven" in the next decade.

Noting that malignant brain tumours represent "a life-ending diagnosis", he adds: "We are currently experiencing a reactively unchecked and dangerous situation." He fears that "unless the industry and governments take immediate and decisive steps", the incidence of malignant brain tumours and associated death rate will be observed to rise globally within a decade from now, by which time it may be far too late to intervene medically.

"It is anticipated that this danger has far broader public health ramifications than asbestos and smoking," says Professor Khurana, who told the IoS his assessment is partly based on the fact that three billion people now use the phones worldwide, three times as many as smoke. Smoking kills some five million worldwide each year, and exposure to asbestos is responsible for as many deaths in Britain as road accidents.

Late last week, the Mobile Operators Association dismissed Khurana's study as "a selective discussion of scientific literature by one individual". It believes he "does not present a balanced analysis" of the published science, and "reaches opposite conclusions to the WHO and more than 30 other independent expert scientific reviews".

Sidney Wolf is a shameless self promoter. Don't pay any attention to him. chantix is one of the greatest medicines that has come out in years. I can't tell you how many patients I have who have been able to quit smoking because of this revolutionary drug. No it is not perfect but the risks are so overblown. Don't for one minute think that the holier than thou anti-pharma crowd doesn't make money off their side of the equation. And this includes some of the narcissistic self promoters at the Cleveland clinic:

CHICAGO - The federal government's new advice to doctors for helping smokers quit recommends the drug Chantix, which has recently been linked with depression and suicidal behavior. The new guidelines mention the psychiatric risks but also say the popular Pfizer Inc. drug is the most effective at helping people get off cigarettes.ADVERTISEMENT

The guidelines mention other options, too, and highly recommend combining counseling and medication. But doctors are encouraged to talk to all smokers who want to quit about trying medication.

Consumer advocates cautioned that the safety picture on Chantix is incomplete because it's a relatively new drug, on the market just since 2006.

"It is somewhat better than other therapies; on the other hand, it appears to have more risk," said Dr. Sidney Wolfe of the watchdog group Public Citizen. "That part of the risk-benefit equation is missing, and it's changing rapidly."

Another issue with the quit-smoking guidelines, released this week by the U.S. Public Health Service, is the lead author's past connections with Pfizer. Dr. Michael Fiore, an expert on smoking and health issues, was a consultant to the maker of Chantix. But he said he cut those ties in 2005.

Fiore's views are shaped by his past ties to the drug industry, and those ties still pose a conflict, at least one consumer advocate said. John Polito, a smoking cessation educator who runs the WhyQuit.com site advocating quitting "cold turkey," called the revised guidelines "a sales pitch" for the drug industry.

"People are quitting smoking to save their lives," Polito said. If Chantix's risks outweigh its benefits, "then it's insane for people to risk their lives" by using it, he said.

The guidelines are based on an extensive review of scientific evidence, were reviewed by 90 independent experts and were endorsed by 60 public health entities, Fiore said, adding that his past financial ties to the drug industry had no influence.

"Independent reviewers of it came to the conclusion that this is a document that reflects the science, and that's what we were charged to do," Fiore said.

The guideline authors analyzed 83 studies and found that Chantix helped 33 percent stay off tobacco for six months after quitting, compared with a nearly 14 percent abstinence rate for dummy pills.

The guidelines recommend combining counseling and medication as the most effective way to kick the tobacco habit, stating "both counseling and medication should be provided to patients trying to quit smoking."

Medications have not been shown to be effective in certain groups, the guidelines say. Those groups include pregnant women, smokeless tobacco users, light smokers and adolescents.

The guidelines say doctors should consider asking about their patients' psychiatric history before prescribing Chantix. Doctors also should monitor patients for changes in mood and behavior while on the drug.

I really can't believe I am reading this stuff about chantix. I can't tell you the miracle this drug has been for some patients. I am telling you some of these anti-pharma people are total crack pots. They are making lots of money with their anti-pharma agenda.The truth is in my practice that people who complain of side effects from this drug are almost without exception people who really didn't want to quit to start with. They are using any excuse, consciously or unconsciously, to say they "can't" quit. The people who tell me before starting the drug they *really want* to quit and want to try the drug or anything else that works, do very well with it. I am saying without any uncertain terms that this guy sidney wolfe, and his like, are doing far more harm then good. Now I get people who have smoked for decades who are now reluctant to use chantix because of all the negative publicity from these self important big mouth jerks.Someone should start investigating these prima donnas like Wolfe, like Nissan, like Topol from the Cleveland Clinic. I guarantee they are getting rich.

While listening to the cable news this am, I notice two well know causes of seizures in older folks where conveniently left off the list; what should be included are cancers, primary and metastatic, and either intoxication or withdrawal from alcohol use. Even sleep deprivation can in certain circumstances trigger one.

I have found this to be true at times. It is certainly one of the hardest things in medicine. There are different reasons for this. Sometimes the patients only hear what they want to hear, and that they *were* told. Sometimes they refuse to give up so the doctor keeps trying things that he/she knows would be a near miracle to work. Sometimes I just wonder if the doctor just doesn't have the guts (or the heart) to tell the patient. There are some cultures where it may actually be considered rude to tell a patient h/she is going to die (such as Japanese). Could there be a financial incentive to push chemo that will have (if no chance) almost no chance to work? I have no direct knowledge of this but in this world nothing would surprise me frankly. I wonder what was told to Ed Kennedy? I would like to think it was all an honorable try at making every possible, remote, theoretical, or otherwise experimental stab at trying to prolong his life but there is something just so self serving from these people at Duke in all this celebration of their supposed leadership in this area of medicine - I just don't know.

***APMost cancer doctors avoid saying it's the end

By MARILYNN MARCHIONE, AP Medical Writer Sun Jun 15, 2:08 PM ET

CHICAGO - One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived.ADVERTISEMENT

He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care.

"At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan, who now is making a "bucket list" — things to do before she dies. Top priority: getting her busy sons to come for a weekend at her Washington, D.C., home.

Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive.

New research shows they are wrong.

Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

Convinced of such benefits and that patients have a right to know, the California Assembly just passed a bill to require that health care providers give complete answers to dying patients who ask about their options. The bill now goes to the state Senate.

Some doctors' groups are fighting the bill, saying it interferes with medical practice. But at an American Society of Clinical Oncology conference in Chicago earlier this month, where the federally funded study was presented, the society's president said she was upset at its finding that most doctors were not having honest talks.

"That is distressing if it's true. It says we have a lot of homework to do," said Dr. Nancy Davidson, a cancer specialist at Johns Hopkins University in Baltimore.

Doctors mistakenly fear that frank conversations will harm patients, said Barbara Coombs Lee, president of the advocacy group Compassionate Choices.

"Boiled down, it's 'Talking about dying will kill you,'" she said. In reality, "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone. No one is willing to talk about it."

The new study is the first to look at what happens to patients if they are or are not asked what kind of care they'd like to receive if they were dying, said lead researcher Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston.

It involved 603 people in Massachusetts, New Hampshire, Connecticut and Texas. All had failed chemotherapy for advanced cancer and had life expectancies of less than a year. They were interviewed at the start of the study and are being followed until their deaths. Records were used to document their care.

Of the 323 who have died so far, those who had end-of-life talks were three times less likely to spend their final week in intensive care, four times less likely to be on breathing machines, and six times less likely to be resuscitated.

About 7 percent of all patients in the study developed depression. Feeling nervous or worried was no more common among those who had end-of-life talks than those who did not.

That rings true, said Marshall, who is Mulligan's doctor at Georgetown University's Lombardi Comprehensive Cancer Center. Patients often are relieved, and can plan for a "good death" and make decisions, such as do-not-resuscitate orders.

"It's sad, and it's not good news, but you can see the tension begin to fall" as soon as the patient and the family come to grips with a situation they may have suspected but were afraid to bring up, he said.

From an ethics point of view, "it's easy — patients ought to know," said Dr. Anthony Lee Back of the Fred Hutchinson Cancer Center in Seattle. "Talking about prognosis is where the rubber meets the road. It's a make-or-break moment — you earn that trust or you blow it," he told doctors at a training session at the cancer conference on how to break bad news.

People react differently, though, said Dr. James Vredenburgh, a brain tumor specialist at Duke University.

"There are patients who want to talk about death and dying when I first meet them, before I ever treat them. There's other people who never will talk about it," he said.

"Most patients know in their heart" that the situation is grim, "but people have an amazing capacity to deny or just keep fighting. For a majority of patients it's a relief to know and to just be able to talk about it," he said.

Sometimes it's doctors who have trouble accepting that the end is near, or think they've failed the patient unless they keep trying to beat the disease, said Dr. Otis Brawley, chief medical officer at the American Cancer Society.

"I had seven patients die in one week once," Brawley said. "I actually had some personal regrets in some patients where I did not stop treatment and in retrospect, I think I should have."

James Rogers, 67 of Durham, N.C., wants no such regrets. Diagnosed with advanced lung cancer last October, he had only one question for the doctor who recommended treatment.

"I said 'Can you get rid of it?' She said 'no,'" and he decided to simply enjoy his final days with the help of the hospice staff at Duke.

"I like being told what my health condition is. I don't like beating around the bush," he said. "We all have to die. I've had a very good life. Death is not something that was fearful to me."***

For those from the old DMG board recall the poster that passed away from melanoma? He had gone to Germany to try experimental immune therapy. It appears at least for some patients it works if done right. A patient of mine who had a form of testicular that does not respond to chemo also tried this form of therapy in Germany. He recently didn't make it. He was only 29. What he went through was horrendous. He fought far harder than Lance Armstrong. He was not lucky like him to have happened to have a cancer that responded to chemo (and didn't cheat and take performance enhancing drugs like him either and later lie about it).

The results of a new study conducted by a researcher team at the Fred Hutchinson Cancer Research Center in Seattle, give hope for those suffering from melanoma, one of the rarer types of skin cancer but the one which causes the majority of skin cancer related deaths.

Researchers who took part in the study used a patient's cloned T cells (helper cells) to put an advanced cancer into complete remission. Nine patients took part in the experimental melanoma treatment program.

The researchers were very surprised after they treated a 52-year-old man from Oregon of his Stage 4 melanoma. The research team led by Cassian Yee, M.D., an associate member of the Clinical Research Division at the Center, took CD4+T cells (white blood cells) from the patient’s body and during the next three months it grew approximately 5 billion of the cells in the lab. Then the cells grown in the lab were injected back into the patient.

After just two months, PET and CT scans revealed no sign of tumors anywhere in the patient's body and there were no harmful side effects. Two years later, patient "Number Four" was checked again and he was still disease free.

However, the first three patients, who received a smaller dose, had no response at all. Some other patients who received the same dose didn’t respond as well as patient number 4 did, but did saw some improvement.

Steven Rosenberg, chief surgeon at the National Cancer Institute, described the form of treatment as “the ultimate personalized medicine,” but also added that the fact that it’s a labor intensive treatment doesn’t make very attractive to commercial development.

The results of the study have been published in this week's issue of the New England Journal of Medicine, and are the latest findings in the field of "adoptive immunotherapy," a theory according to which the human body can be taught to fight off its own cancers.***

The only negative article was from I think New Zealand which noted in a small group of people a negative associated with increased Vitamin D intake and coronarly artery calcification but everything else I read suggested Vitamin D deficiency or insufficiency is under treated and diagnosed. Vit D level over 40 is associated with decreased bone fracture risk this that is the goal I shoot for.Proabably half the people I measure 25 hydroxy vitamin D levels in are below this level.

CHICAGO - New research linking low vitamin D levels with deaths from heart disease and other causes bolsters mounting evidence about the "sunshine" vitamin's role in good health.

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Patients with the lowest blood levels of vitamin D were about two times more likely to die from any cause during the next eight years than those with the highest levels, the study found. The link with heart-related deaths was particularly strong in those with low vitamin D levels.

Experts say the results shouldn't be seen as a reason to start popping vitamin D pills or to spend hours in the sun, which is the main source for vitamin D.

For one thing, megadoses of vitamin D pills can be dangerous and skin cancer risks from too much sunshine are well-known. But also, it can't be determined from this type of study whether lack of vitamin D caused the deaths, or whether increasing vitamin D intake would make any difference.

Low vitamin D levels could reflect age, lack of physical activity and other lifestyle factors that also affect health, said American Heart Association spokeswoman Alice Lichtenstein, director of the Cardiovascular Nutrition Laboratory at Tufts University.

Still, she said the study is an important addition to an emerging area of research.

"This is something that should not be ignored," Lichtenstein said.

The study led by Austrian researchers involved 3,258 men and women in southwest Germany. Participants were aged 62 on average, most with heart disease, whose vitamin D levels were checked in weekly blood tests. During roughly eight years of follow-up, 737 died, including 463 from heart-related problems.

According to one of the vitamin tests they used, there were 307 deaths in patients with the lowest levels, versus 103 deaths in those with the highest levels. Counting age, physical activity and other factors, the researchers calculated that deaths from all causes were about twice as common in patients in the lowest-level group.

Results appear in Monday's Archives of Internal Medicine.

The study's lead author, Dr. Harald Dobnig of the Medical University of Graz in Austria, said the results don't prove that low levels of vitamin D are harmful "but the evidence is just becoming overwhelming at this point."

Scientists used to think that the only role of vitamin D was to prevent rickets and strengthen bones, Dobnig said.

"Now we are beginning to realize that there is much more into it," he said

Exactly how low vitamin D levels might contribute to heart problems and deaths from other illnesses is uncertain, although it is has been shown to help regulate the body's disease-fighting immune system, he said.

Earlier this month, the same journal included research led by Harvard scientists linking low vitamin D levels with heart attacks. And previous research has linked low vitamin D with high blood pressure, diabetes and obesity, which all can contribute to heart disease.

The new research "provides the strongest evidence to date for a link between vitamin D deficiency and cardiovascular mortality," said Dr. Edward Giovannucci of the Harvard study of 18,225 men.

Low vitamin D levels also have been linked with several kinds of cancer and some researchers believe the vitamin could even be used to help prevent malignancies.

It has been estimated that at least 50 percent of older adults worldwide have low vitamin D levels, and the problem is also thought to affect substantial numbers of younger people. Possible reasons include decreased outdoor activities, air pollution and, as people age, a decline in the skin's ability to produce vitamin D from ultraviolet rays, the study authors said.

Some doctors believe overuse of sunscreen lotions has contributed, and say just 10 to 15 minutes daily in the sun without sunscreen is safe and enough to ensure adequate vitamin D, although there's no consensus on that.

The Institute of Medicine's current vitamin D recommendations are 200 units daily for children and adults up to age 50, and 400 to 600 units for older adults. But some doctors believe these amounts are far too low and recommend taking supplements.

The American Medical Association at its annual meeting last week agreed to urge a review of the recommendations.***

A leading drug company may be poised to win a landmark legal victory next fall. If the drug manufacturer, Wyeth, prevails in a case soon to be argued before the U.S. Supreme Court (Wyeth v. Levine),1 drug companies could effectively be immunized against state-level tort litigation if their products that have been approved by the Food and Drug Administration (FDA) are later found to be defective.

A medical-device company won such a victory in April. In Riegel v. Medtronic,2 the Supreme Court determined that a product-liability lawsuit against Medtronic in a state court was preempted because the device had received FDA approval. Preemption is a legal doctrine based on the supremacy clause of the U.S. Constitution, which states that when federal and state laws are at odds, federal law takes precedence. Its application to state tort litigation is a radical extension of its original meaning.

Medtronic won its case because the 1976 law that grants the FDA authority to regulate medical devices contains a clause asserting that state requirements with regard to medical devices are preempted by federal requirements. Although the preemption clause is silent on common-law tort actions, the Supreme Court (with Justice Antonin Scalia writing for the Court) interpreted the preemption clause broadly to include such actions.

Unlike the law governing medical devices, the Food, Drug, and Cosmetic Act, which provides the statutory framework for the regulation of drugs by the FDA, contains no such preemption clause. Thus, in Wyeth v. Levine — which concerns a patient who lost her arm after an injection of Wyeth's antiemetic drug Phenergan — the Court will decide whether preemption of state tort litigation is implied by the law, even though it is not explicitly stated.

Previous administrations and the FDA considered tort litigation to be an important part of an overall regulatory framework for drugs and devices; product-liability litigation by consumers was believed to complement the FDA's regulatory actions and enhance patient safety. Margaret Jane Porter, former chief counsel of the FDA, wrote, "FDA product approval and state tort liability usually operate independently, each providing a significant, yet distinct, layer of consumer protection."3 Persons who are harmed have the right to seek legal redress. Preemption would erase that right.

But in the past few years, the government's views have shifted, and the FDA has reversed its position, now claiming that common-law tort actions are preempted. The FDA argues that tort liability stifles innovation in product development and delays the approval process, and that lay juries are incapable of making determinations about product safety. It has been argued, however, that Congress, not unelected appointees of a federal agency, has the power to decide whether preemption should apply.

Drug and device companies have chosen an inauspicious moment to attack the right of patients to seek redress. A series of pivotal reports on patient safety from the Institute of Medicine, as well as numerous articles in scholarly journals, has put the issue of patient safety in the national spotlight. Although frivolous lawsuits should not be condoned, product-liability litigation has unquestionably helped to remove unsafe products from the market and to prevent others from entering it. Through the process of legal discovery, litigation may also uncover information about drug toxicity that would otherwise not be known. Preemption will thus result in drugs and devices that are less safe and will thereby undermine a national effort to improve patient safety.

Owing in part to a lack of resources, approval of a new drug by the FDA is not a guarantee of its safety (see timeline).4 As the Institute of Medicine has reported, FDA approval is usually based on short-term efficacy studies, not long-term safety studies.5 Despite the diligent attention of the FDA, serious safety issues often come to light only after a drug has entered the market. The FDA, which — unlike most other federal agencies — has no subpoena power, knows only what manufacturers reveal.

Figure 1View larger version (41K):[in this window][in a new window]Get Slide Four Drugs with Safety Problems Discovered after FDA Approval.

Why should doctors be concerned about preemption? In stripping patients of their right to seek redress through due process of law, preemption of common-law tort actions is not only unjust but will also result in the reduced safety of drugs and medical devices for the American people. Preemption will undermine the confidence that doctors and patients have in the safety of drugs and devices. If injured patients are unable to seek legal redress from manufacturers of defective products, they may instead turn elsewhere.

In May, a Congressional hearing on preemption was held by Representative Henry Waxman (D-CA) and the House Committee on Oversight and Government Reform. As we stated in our testimony to the committee, to ensure the safety of medical devices, we urge Congress to act quickly to reverse the Riegel decision. Congressman Waxman and Congressman Frank Pallone, Jr. (D-NJ), are poised to introduce legislation that would unambiguously eliminate the possibility of preemption of common-law tort actions for medical devices. And if the Supreme Court rules for preemption in Wyeth v. Levine, which we hope it will not, Congress should consider similar legislation for drugs. Such legislation is in the best interest of the health and safety of the American public.

Source Information

Dr. Curfman is the executive editor, Dr. Morrissey the managing editor, and Dr. Drazen the editor-in-chief of the Journal.

An interactive timeline is available with the full text of this article at www.nejm.org.

Nutritionist and author Jonny Bowden has created several lists of healthful foods people should be eating but aren’t. But some of his favorites, like purslane, guava and goji berries, aren’t always available at regular grocery stores. I asked Dr. Bowden, author of “The 150 Healthiest Foods on Earth,” to update his list with some favorite foods that are easy to find but don’t always find their way into our shopping carts. Here’s his advice.Beets: Think of beets as red spinach, Dr. Bowden said, because they are a rich source of folate as well as natural red pigments that may be cancer fighters.How to eat: Fresh, raw and grated to make a salad. Heating decreases the antioxidant power. Cabbage: Loaded with nutrients like sulforaphane, a chemical said to boost cancer-fighting enzymes.How to eat: Asian-style slaw or as a crunchy topping on burgers and sandwiches. Swiss chard: A leafy green vegetable packed with carotenoids that protect aging eyes.How to eat it: Chop and saute in olive oil. Cinnamon: May help control blood sugar and cholesterol.How to eat it: Sprinkle on coffee or oatmeal. Pomegranate juice: Appears to lower blood pressure and loaded with antioxidants.How to eat: Just drink it. Dried plums: Okay, so they are really prunes, but they are packed with antioxidants.How to eat: Wrapped in prosciutto and baked. Pumpkin seeds: The most nutritious part of the pumpkin and packed with magnesium; high levels of the mineral are associated with lower risk for early death.How to eat: Roasted as a snack, or sprinkled on salad. Sardines: Dr. Bowden calls them “health food in a can.'’ They are high in omega-3’s, contain virtually no mercury and are loaded with calcium. They also contain iron, magnesium, phosphorus, potassium, zinc, copper and manganese as well as a full complement of B vitamins.How to eat: Choose sardines packed in olive or sardine oil. Eat plain, mixed with salad, on toast, or mashed with dijon mustard and onions as a spread. Turmeric: The “superstar of spices,'’ it may have anti-inflammatory and anti-cancer properties.How to eat: Mix with scrambled eggs or in any vegetable dish. Frozen blueberries: Even though freezing can degrade some of the nutrients in fruits and vegetables, frozen blueberries are available year-round and don’t spoil; associated with better memory in animal studies.How to eat: Blended with yogurt or chocolate soy milk and sprinkled with crushed almonds. Canned pumpkin: A low-calorie vegetable that is high in fiber and immune-stimulating vitamin A; fills you up on very few calories.How to eat: Mix with a little butter, cinnamon and nutmeg.

ATLANTA — The Atkins diet may have proved itself after all: A low-carb diet and a Mediterranean-style regimen helped people lose more weight than a traditional low-fat diet in one of the longest and largest studies to compare the dueling weight-loss techniques.

A bigger surprise: The low-carb diet improved cholesterol more than the other two. Some critics had predicted the opposite.

"It is a vindication," said Abby Bloch of the Dr. Robert C. and Veronica Atkins Foundation, a philanthropy group that honors the Atkins' diet's creator and was the study's main funder.

However, all three approaches — the low-carb diet, a low-fat diet and a so-called Mediterranean diet — achieved weight loss and improved cholesterol.

The study is remarkable not only because it lasted two years, much longer than most, but also because of the huge proportion of people who stuck with the diets — 85 percent.

Researchers approached the Atkins Foundation with the idea for the study. But the foundation played no role in the study's design or reporting of the results, said the lead author, Iris Shai of Ben-Gurion University of the Negev.

Other experts said the study — being published Thursday in the New England Journal of Medicine — was highly credible.

"This is a very good group of researchers," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.

The research was done in a controlled environment — an isolated nuclear research facility in Israel. The 322 participants got their main meal of the day, lunch, at a central cafeteria.

"The workers can't easily just go out to lunch at a nearby Subway or McDonald's," said Dr. Meir Stampfer, the study's senior author and a professor of epidemiology and nutrition at the Harvard School of Public Health.

In the cafeteria, the appropriate foods for each diet were identified with colored dots, using red for low-fat, green for Mediterranean and blue for low-carb.

As for breakfast and dinner, the dieters were counseled on how to stick to their eating plans and were asked to fill out questionnaires on what they ate, Stampfer said.

The low-fat diet — no more than 30 percent of calories from fat — restricted calories and cholesterol and focused on low-fat grains, vegetables and fruits as options. The Mediterranean diet had similar calorie, fat and cholesterol restrictions, emphasizing poultry, fish, olive oil and nuts.

The low-carb diet set limits for carbohydrates, but none for calories or fat. It urged dieters to choose vegetarian sources of fat and protein."So not a lot of butter and eggs and cream," said Madelyn Fernstrom, a University of Pittsburgh Medical Center weight management expert who reviewed the study but was not involved in it.

Most of the participants were men; all men and women in the study got roughly equal amounts of exercise, the study's authors said.

Average weight loss for those in the low-carb group was 10.3 pounds after two years. Those in the Mediterranean diet lost 10 pounds, and those on the low-fat regimen dropped 6.5.

More surprising were the measures of cholesterol. Critics have long acknowledged that an Atkins-style diet could help people lose weight but feared that over the long term, it may drive up cholesterol because it allows more fat.

But the low-carb approach seemed to trigger the most improvement in several cholesterol measures, including the ratio of total cholesterol to HDL, the "good" cholesterol. For example, someone with total cholesterol of 200 and an HDL of 50 would have a ratio of 4 to 1. The optimum ratio is 3.5 to 1, according to the American Heart Association.

Doctors see that ratio as a sign of a patient's risk for hardening of the arteries. "You want that low," Stampfer said.

The ratio declined by 20 percent in people on the low-carb diet, compared to 16 percent in those on the Mediterranean and 12 percent in low-fat dieters.

The study is not the first to offer a favorable comparison of an Atkins-like diet. Research published in the Journal of the American Medical Association last year found overweight women on the Atkins plan had slightly better blood pressure and cholesterol readings than those on the low-carb Zone diet, the low-fat Ornish diet and a low-fat diet that followed U.S. government guidelines.

The heart association has long recommended low-fat diets to reduce heart risks, but some of its leaders have noted the Mediterranean diet has also proven safe and effective.

The heart association recommends a low-fat diet even more restrictive than the one in the study, said Dr. Robert Eckel, the association's past president who is a professor of medicine at the University of Colorado-Denver.

It does not recommend the Atkins diet. However, a low-carb approach is consistent with heart association guidelines so long as there are limitations on the kinds of saturated fats often consumed by people on the Atkins diet, Eckel said.

The new study's results favored the Atkins-like approach less when subgroups such as diabetics and women were examined.Among the 36 diabetics, only those on the Mediterranean diet lowered blood sugar levels. Among the 45 women, those on the Mediterranean diet lost the most weight.

"I think these data suggest that men may be much more responsive to a diet in which there are clear limits on what foods can be consumed," such as an Atkins-like diet, said Dr. William Dietz, of the Centers for Disease Control and Prevention.

"It suggests that because women have had more experience dieting or losing weight, they're more capable of implementing a more complicated diet," said Dietz, who heads CDC's nutrition unit.

By JANE E. BRODYPublished: July 15, 2008My friend Anne and her husband, Richard, spend summers at a resort in Westchester County that has a swimming lake, tennis courts, gardens and beautiful grounds surrounded by woods. But Anne never sets foot on the grass.

The reason is Lyme disease. Anne says just about everyone she knows who partakes of the greenery and gardens outside the cabins has contracted the disease. So not only is she cautious about venturing out, but she and her husband also check each other daily from head to toe for the much-feared deer tick, which can transmit the disease when it attaches to skin and feeds on blood.

This tick, which is the size of a pinhead when it starts searching for a bloody meal, is responsible for about 20,000 reported cases of Lyme disease each year in the United States (the actual number is believed to be 10 times that) and 60,000 reported cases in Europe. Cases have been reported in every state, with residents of the Northeast, the Great Lakes region, northwestern Washington and parts of California the most frequent victims.

In some areas, as many as half of the deer ticks are infected with Borrelia, the Lyme disease bacteria. The disease got its name in 1975 from the first identified cluster of cases, among children in Lyme, Conn., who had rheumatoid-like symptoms of swollen, painful joints.

The white-tailed deer and white-footed mouse are the tick’s most frequent hosts, but it also feeds on birds, dogs and other rodents, including squirrels. The tiny nymphal form that emerges in spring and early summer presents the greatest hazard to humans. It is also the hardest to spot, especially on body parts covered with hair.

People usually acquire the tick while walking through grassy or wooded areas. Sometimes pet dogs are the source: in Minnesota one summer, our dog got more than 30 deer ticks on his face, apparently from sticking his nose into a fresh carcass. Unlike the common dog tick, which is round and very dark, the deer tick is elongated and brownish.

A Challenging Diagnosis

The disease can be maddeningly difficult to diagnose. Only 50 to 70 percent of patients recall being bitten by a tick. Ordinary laboratory tests are rarely helpful. Tests for antibodies to the bacterium or for its genetic footprints result in many false-negative and false-positive findings.

Rather, according to Dr. Robert L. Bratton and colleagues at the Mayo Clinic in Scottsdale, Ariz., who reviewed the recent literature on Lyme disease in the May issue of Mayo Clinic Proceedings, most cases are best diagnosed and treated based on patients’ symptoms. Thus, doctors everywhere must be alert when dealing with patients who live or travel in areas where Lyme disease is prevalent, and they must be willing to use appropriate antibiotics based on a clinical assessment rather than laboratory findings.

Since signs and symptoms vary and often do not appear until one to four weeks — or even months — after exposure, anyone bitten by a deer tick may be wise to obtain preventive treatment with an antibiotic, according to Lyme disease experts consulted by Constance A. Bean, the author with Dr. Lesley Ann Fein of the new book “Beating Lyme” (Amacom Books).

The most common sign is a reddish rash called erythema migrans that often resembles a spreading bull’s-eye, though up to 20 percent of patients never develop it. Common sites of the rash are the thigh, groin, buttock and underarm. It may be accompanied by flulike symptoms: fever, chills, body aches, headache and fatigue.

If untreated or inadequately treated, the infection can cause severe migrating joint pain and swelling, most often in the knees, weeks or months later. In addition, several weeks, months or even years after an untreated infection, the bacterium can cause meningitis, temporary facial paralysis, numbness or weakness of the arms and legs, memory and concentration difficulties and changes in mood, personality or sleep habits. Some untreated patients develop temporary heart rhythm abnormalities, eye inflammation or hepatitis.

Controversial Guidelines

Antibiotics for early Lyme disease should be taken for at least two to three weeks. The treatments recommended by the Infectious Diseases Society of America include doxycycline for nonpregnant patients and children 9 and older, or amoxicillin for pregnant women and younger children. Other options include cefuroxime axetil (Ceftin) and erythromycin.

But these guidelines are controversial. They have been challenged by a nonprofit medical group, the International Lyme and Associated Diseases Society, which says they are inadequate to combat the infection in a significant number of patients, who go on to develop debilitating chronic symptoms.

In May, the Infectious Diseases Society agreed to review its guidelines as a result of an antitrust lawsuit by the Connecticut attorney general, Richard Blumenthal, who said some of the society’s experts had financial interests that could bias their judgment. (The society denied that accusation.)

Although I cannot state with authority which side is correct, I have encountered enough previously healthy people who have suffered for months or years after initial treatment to suggest that there is often more to this disease than “official” diagnostic and treatment guidelines suggest.

Pamela Weintraub, a senior editor at Discover magazine, has produced a thoroughly researched and well-written account of the disease’s controversial history in her new book “Cure Unknown: Inside the Lyme Epidemic” (St. Martin’s Press).

Treatment and Prevention

The Mayo doctors concluded that patients who developed arthritis related to Lyme disease should be treated for one to two months and that those with late or severe disease, including neurological and cardiac symptoms, required intravenous antibiotics. Although two studies, neither of which was long-term, found that repeated antibiotic treatment did not reverse the pain and altered cognition associated with Lyme disease, the experience of thousands of patients, including Ms. Bean, contradict these findings.

There are no vaccines to prevent Lyme disease; an early attempt was taken off the market in 2002 because of side effects and limited effectiveness. Those who will not or cannot avoid grassy and wooded areas should wear long sleeves and long pants with legs tucked into socks, and spray exposed skin and clothing with tick repellent containing 20 to 30 percent DEET. Repellents should not be used on children under 2.

Since the tick must usually feed for 24 hours to transmit significant amounts of bacteria, daily body checks and showering with a washcloth can help prevent infection. Clothing should be washed and dried in a dryer. Additional preventive actions are described in “Beating Lyme.”

If a tick is attached to skin, it should be removed with tweezers, not fingers. Press into the skin, grasp the front of the tick’s head and pull at right angles to the skin. Place the tick in a sealed plastic bag for later identification. Then wash the area and your hands thoroughly.

This article offers a general overview on Lyme disease. For specific information see:

Stage 1 Lyme disease Stage 2 Lyme disease Stage 3 Lyme disease See All » News & Features A Threat in a Grassy Stroll: Lyme Disease Prognosis: Prolonged Use of Antibiotics After Lyme May Not Help Reference from A.D.A.M.Back to TopAlternative NamesBorreliosis

Back to TopCausesLyme disease is caused by the bacteria Borrelia burgdorferi (B. burgdorferi). Certain ticks carry the bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with Lyme disease. You can get the disease if you are bitten by an infected tick.

Lyme disease was first reported in the United States in the town of Old Lyme, Connecticut in 1975. Cases have now been reported in most parts of the United States. Most occur in the Northeast, upper Midwest, and along the Pacific coast. Lyme disease is usually seen during the late spring, summer, and early fall.

There are three stages of Lyme disease.

Stage 1 is called primary Lyme disease. Stage 2 is called secondary Lyme disease. Stage 3 is called tertiary Lyme disease. Risk factors for Lyme disease include walking in high grasses, taking place in activities that increase tick exposure, and having a pet that may carry ticks home.

Back to TopSymptoms »Not everyone infected with the bacteria gets ill. If a person does become ill, the first symptoms resemble the flu and include fever, headache, chills, muscle pain, and lethargy.

There may be a "bulls-eye" rash, a flat or slightly raised red spot at the site of the tick bite often with a clear area in the center. This lesion can be larger than 1 to 3 inches wide.

Stiff neck, joint inflammation, body-wide itching, unusual or strange behavior, and other symptoms may be seen in persons with later stages of the disease.

Note: Deer ticks can be so small that they are almost impossible to see. Therefore, many people with Lyme disease never even saw a tick. These people are more likely to develop symptoms because the tick remained on their body longer.

In-Depth Symptoms »Back to TopExams and Tests »A blood test can be done to check for antibodies to the bacteria that causes Lyme disease. The most common one used is the ELISA for Lyme disease test. A western blot test is done to confirm ELISA results.

A physical exam may reveal signs of joint, heart, or brain problems in persons with advanced Lyme disease.

In-Depth Diagnosis »Back to TopTreatment »Antibiotics are used to treat Lyme disease. The specific antibiotic used depends on the stage of the disease and your symptoms.

Anti-inflammatory medications, such as ibuprofen, are sometimes prescribed to relieve joint stiffness.

In-Depth Treatment »Back to TopOutlook (Prognosis)If diagnosed in the early stages, Lyme disease can be cured with antibiotics. Without treatment, complications involving joints, the heart, and the nervous system can occur.

Back to TopPossible ComplicationsAdvanced stages of Lyme disease can cause long-term joint inflammation (Lyme arthritis) and heart rhythm problems. Neurological problems are also possible, and may include:

Back to TopPrevention »When walking or hiking in wooded or grassy areas, tuck long pants into socks to protect the legs, and wear shoes and light-colored, long-sleeved shirts. Ticks show up better on white or light colored-clothing than dark items. Spray your clothes with insect repellant.

Check yourself and your pets frequently. If you find ticks, remove them immediately by using tweezers, pulling carefully and steadily.

Ticks that carry Lyme disease are usually so small that they are almost impossible to see. After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp.

In the late eighties I was involved in the care of a patient who had this rash. The only explanation for his getting this rash that we could come up with was over-the-counter advil. We contemplated the thought - why everyone takes advil. There are reports of the rash being associated with many other things. It is extremely rare.

The jury in the $1 billion lawsuit against Children's Motrin, a widely-used pain reliever, has decided that the drugmaker, Johnson & Johnson, is not liable for damages experienced by Sabrina Johnson, a California girl, now 11, whose parents say she suffered pain and blindness after they gave her recommended doses of the drug in 2003.

Deliberating in Malibu, Calif., in Los Angeles Superior Court, the jurors took three and a half days to come to their decision.

The verdict, which came down Thursday afternoon, sparked outrage from the attorney of the girl's family and a reaffirmation from McNeil Consumer Health Care, the J & J subsidiary that makes Children's Motrin (Ibuprofen), that their drug is safe and effective.Children's Motrin Case: Attorney of Girl's Family Reacts

"The jury found in this case that Johnson & Johnson and McNeil, their wholly owned subsidiary, knew of the dangerous risk of side effects inherent in this drug," says Browne Greene of Greene, Broillet, and Wheeler in Santa Monica, Calif. "It found they failed to warn adequately of these risks and yet found the failing to warn had nothing to do with the injuries. In other word they found that a better warning would not have made a difference."

In a prepared statement, spokesman Marc Boston of McNeil says: ''McNeil PPC Inc., agrees with the outcome of today's verdict. As the makers of Children's Motrin (ibuprofen), we are deeply concerned about all matters related to our medicines and are committed to providing safe and effective medicines. While we are sympathetic to the pain and hardship suffered by Sabrina Johnson, Children's Motrin has been proven safe and effective for the treatment of minor aches and pains and fever when used as directed and the medicine is labeled appropriately. We strongly recommend consumers read the product label for dosing information and warnings and talk with their health care professional if they have any questions or concerns."Children's Motrin Case: Back Story

Sabrina Johnson's parents gave her the drug to treat a fever when she returned from school one afternoon and again that night, Greene says, "and all that led to Stevens-Johnson syndrome."

Stevens-Johnson syndrome is a rare and serious disorder of the skin and mucous membranes. The cause is not always clear, according to experts at Mayo Clinic, but is usually a type of allergic reaction in response to medication or infection.

Among the symptoms and signs are facial swelling, blisters on the skin, and mucous membranes, especially in the eyes, nose and mouth.

The next morning, according to the lawsuit, Sabrina woke with a high fever. Her eyes had turned pink and her mouth was swollen and had sores. At the hospital, she was diagnosed with Stevens-Johnson syndrome. The damage to the eyes caused great pain, Greene says, and eventually blinded her. While prescription versions of ibuprofen have the warning about the link to Stevens-Johnson, he says, over-the -counter versions do not.

The Malibu case is one of about 60 such lawsuits against Children's Motrin, according to Greene, who is representing two other families. Greene's clients asked for slightly less than a billion dollars, he tells WebMD, including actual damages, pain and suffering, and punitive damages.

The verdict may not mean other cases won't go the other way, says Miles Cooper, an attorney with The Veen Firm in San Francisco, who has experience in product liability cases.

"One verdict is not enough to predict the outcomes of the 60 cases," he tells WebMD. "I expect this case will be appealed by the plaintiffs. And there would need to be at least four to six more cases tried to see what the jurors' trends are."

A physician who has testified in product liability cases says he is not surprised by the verdict. "Many, many OTC [over-the-counter] drugs can cause Stevens-Johnson syndrome," says Neal Benowitz, MD, a professor of medicine and biopharmaceutical sciences at the University of California San Francisco School of Medicine. "It's very rare," he adds.

"Manufacturers cannot put every side effect down on a label, there is just not room. What manufacturers have to do is just pick out the most common and the most serious."***

By TARA PARKER-POPE Published: June 3, 2008What do brain surgeons know about cellphone safety that the rest of us don't?

Last week, three prominent neurosurgeons told the CNN interviewer Larry King that they did not hold cellphones next to their ears. ''I think the safe practice,'' said Dr. Keith Black, a surgeon at Cedars-Sinai Medical Center in Los Angeles, ''is to use an earpiece so you keep the microwave antenna away from your brain.''

Dr. Vini Khurana, an associate professor of neurosurgery at the Australian National University who is an outspoken critic of cellphones, said: ''I use it on the speaker-phone mode. I do not hold it to my ear.'' And CNN's chief medical correspondent, Dr. Sanjay Gupta, a neurosurgeon at Emory University Hospital, said that like Dr. Black he used an earpiece.

Along with Senator Edward M. Kennedy's recent diagnosis of a glioma, a type of tumor that critics have long associated with cellphone use, the doctors' remarks have helped reignite a long-simmering debate about cellphones and cancer.

That supposed link has been largely dismissed by many experts, including the American Cancer Society. The theory that cellphones cause brain tumors ''defies credulity,'' said Dr. Eugene Flamm, chairman of neurosurgery at Montefiore Medical Center.

According to the Food and Drug Administration, three large epidemiology studies since 2000 have shown no harmful effects. CTIA -- the Wireless Association, the leading industry trade group, said in a statement, ''The overwhelming majority of studies that have been published in scientific journals around the globe show that wireless phones do not pose a health risk.''

The F.D.A. notes, however, that the average period of phone use in the studies it cites was about three years, so the research doesn't answer questions about long-term exposures. Critics say many studies are flawed for that reason, and also because they do not distinguish between casual and heavy use.

Cellphones emit non-ionizing radiation, waves of energy that are too weak to break chemical bonds or to set off the DNA damage known to cause cancer. There is no known biological mechanism to explain how non-ionizing radiation might lead to cancer.

But researchers who have raised concerns say that just because science can't explain the mechanism doesn't mean one doesn't exist. Concerns have focused on the heat generated by cellphones and the fact that the radio frequencies are absorbed mostly by the head and neck. In recent studies that suggest a risk, the tumors tend to occur on the same side of the head where the patient typically holds the phone.

Like most research on the subject, the studies are observational, showing only an association between cellphone use and cancer, not a causal relationship. The most important of these studies is called Interphone, a vast research effort in 13 countries, including Canada, Israel and several in Europe.

Some of the research suggests a link between cellphone use and three types of tumors: glioma; cancer of the parotid, a salivary gland near the ear; and acoustic neuroma, a tumor that essentially occurs where the ear meets the brain. All these cancers are rare, so even if cellphone use does increase risk, the risk is still very low.

Last year, The American Journal of Epidemiology published data from Israel finding a 58 percent higher risk of parotid gland tumors among heavy cellphone users. Also last year, a Swedish analysis of 16 studies in the journal Occupational and Environmental Medicine showed a doubling of risk for acoustic neuroma and glioma after 10 years of heavy cellphone use.

''What we're seeing is suggestions in epidemiological studies that have looked at people using phones for 10 or more years,'' says Louis Slesin, editor of Microwave News, an industry publication that tracks the research. ''There are some very disconcerting findings that suggest a problem, although it's much too early to reach a conclusive view.''

----------------

TARA PARKER-POPE

Published: June 3, 2008Some doctors say the real concern is not older cellphone users, who began using phones as adults, but children who are beginning to use phones today and face a lifetime of exposure.

''More and more kids are using cellphones,'' said Dr. Paul J. Rosch, clinical professor of medicine and psychiatry at New York Medical College. ''They may be much more affected. Their brains are growing rapidly, and their skulls are thinner.''

For people who are concerned about any possible risk, a simple solution is to use a headset. Of course, that option isn't always convenient, and some critics have raised worries about wireless devices like the Bluetooth that essentially place a transmitter in the ear.

The fear is that even if the individual risk of using a cellphone is low, with three billion users worldwide, even a minuscule risk would translate into a major public health concern.

''We cannot say with any certainty that cellphones are either safe or not safe,'' Dr. Black said on CNN. ''My concern is that with the widespread use of cellphones, the worst scenario would be that we get the definitive study 10 years from now, and we find out there is a correlation.'' =============================

Does Fructose Make You Fatter?High-fructose corn syrup is a sweetener used in many processed foods ranging from sodas to baked goods. While the ingredient is cheaper and sweeter than regular sugar, new research suggests that it can also make you fatter.In a small study, Texas researchers showed that the body converts fructose to body fat with “surprising speed,'’ said Elizabeth Parks, associate professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas. The study, which appears in The Journal of Nutrition, shows how glucose and fructose, which are forms of sugar, are metabolized differently.In humans, triglycerides, which are a type of fat in the blood, are mostly formed in the liver. Dr. Parks said the liver acts like “a traffic cop” who coordinates how the body uses dietary sugars. When the liver encounters glucose, it decides whether the body needs to store it, burn it for energy or turn it into triglycerides.But when fructose enters the body, it bypasses the process and ends up being quickly converted to body fat. “It’s basically sneaking into the rock concert through the fence,” Dr. Parks said. “It’s a less-controlled movement of fructose through these pathways that causes it to contribute to greater triglyceride synthesis. The bottom line of this study is that fructose very quickly gets made into fat in the body.”For the study, six people were given three different drinks. In one test, the breakfast drink was 100 percent glucose. In the second test, they drank half glucose and half fructose; and in the third, they drank 25 percent glucose and 75 percent fructose. The drinks were given at random, and neither the study subjects nor the evaluators were aware who was drinking what. The subjects ate a regular lunch about four hours later.The researchers found that lipogenesis, the process by which sugars are turned into body fat, increased significantly when the study subjects drank the drinks with fructose. When fructose was given at breakfast, the body was more likely to store the fats eaten at lunch.Dr. Parks noted that the study likely underestimates the fat-building effect of fructose because the study subjects were lean and healthy. In overweight people, the effect may be amplified.Although fruit contains fructose, it also contains many beneficial nutrients, so dieters shouldn’t eliminate fruit from their diets. But limiting processed foods containing high-fructose corn syrup as well as curbing calories is a good idea, Dr. Parks said.“There are lots of people out there who want to demonize fructose as the cause of the obesity epidemic,” she said. “I think it may be a contributor, but it’s not the only problem. Americans are eating too many calories for their activity level. We’re overeating fat, we’re overeating protein and we’re overeating all sugars.”

First of all it *is* genetically and physiologically for all adult Americans to become overweight. Second there are medicines and combinations of medicines that will turn this trend coming. Probably within five and certainly within ten years we will start to see thse medicines coming to the market place. So the answer lies in the pharmaceutical industry.

I've read other evaulations that point out the trend towards heavier weights is starting to level out. That is not to say we don't have a "huge" problem or we shouldn't do more to right this.

But wild extrapolations like this make for good pc correct policy fodder. The "food" police are a wing of the "green" police. They are part of the same weed family whose natural habitat is San Fransisco.

****All U.S. adults could be overweight in 40 years

By Amy Norton Wed Aug 6, 3:12 PM ET

NEW YORK (Reuters Health) - If the trends of the past three decades continue, it's possible that every American adult could be overweight 40 years from now, a government-funded study projects.

The figure might sound alarming, or impossible, but researchers say that even if the actual rate never reaches the 100-percent mark, any upward movement is worrying; two-thirds of the population is already overweight.

"Genetically and physiologically, it should be impossible" for all U.S. adults to become overweight, said Dr. Lan Liang of the federal government's Agency for Healthcare Research and Quality, one of the researchers on the study.

However, she told Reuters Health, the data suggest that if the trends of the past 30 years persist, "that is the direction we're going."

Already, she and her colleagues point out, some groups of U.S. adults have extremely high rates of overweight and obesity; among African- American women, for instance, 78 percent are currently overweight or obese.

The new projections, published in the journal Obesity, are based on government survey data collected between the 1970s and 2004.

If the trends of those years continue, the researchers estimate that 86 percent of American adults will be overweight by 2030, with an obesity rate of 51 percent. By 2048, all U.S. adults could be at least mildly overweight.

Weight problems will be most acute among African-Americans and Mexican- Americans, the study projects. All black women could be overweight by 2034, according to the researchers, as could more than 90 percent of Mexican-American men.

All of this rests on the "big assumption" that the trends of recent decades will march on unabated, Liang acknowledged.

"This is really intended as a wake-up call to show what could happen if nothing changes," she said.

Waistlines aren't the only thing poised to balloon in the future, according to Liang and her colleagues. They estimate that the healthcare costs directly related to excess pounds will double each decade, reaching $957 billion in 2030 -- accounting for one of every six healthcare dollars spent in the

U.S.

Those financial projections are based on Census data and published estimates of the current healthcare costs attributed to excess weight -- and they are probably a "huge underestimate" of what the actual costs will be, Liang said.

The findings highlight a need for widespread efforts to improve Americans' lifestyles and keep their weight in check, according to the researchers. Simply telling people to eat less and exercise more is not enough, Liang noted.

Broader social changes are needed as well, she said -- such as making communities more pedestrian-friendly so that people can walk regularly, or getting the food industry to offer healthier, calorie-conscious choices.

"It really needs to be more than an individual effort," Liang said. "It needs to be a societal effort."